How to Use and Report on p-values.

The use of the p-value in quantitative research, particularly its threshold of "P < 0.05" for determining "statistical significance," has long been a cornerstone of statistical analysis in research. However, this standard has been increasingly scrutinized for its potential to mislead findings, especially when the practical significance, the number of comparisons, or the suitability of statistical tests are not properly considered. In response to controversy around use of p-values, the American Statistical Association published a statement in 2016 that challenged the research community to abandon the term "statistically significant". This stance has been echoed by leading scientific journals to urge a significant reduction or complete elimination in the reliance on p-values when reporting results. To provide guidance to researchers in health professions education, this paper provides a succinct overview of the ongoing debate regarding the use of p-values and the definition of p-values. It reflects on the controversy by highlighting the common pitfalls associated with p-value interpretation and usage, such as misinterpretation, overemphasis, and false dichotomization between "significant" and "non-significant" results. This paper also outlines specific recommendations for the effective use of p-values in statistical reporting including the importance of reporting effect sizes, confidence intervals, the null hypothesis, and conducting sensitivity analyses for appropriate interpretation. These considerations aim to guide researchers toward a more nuanced and informative use of p-values.

The Impact of an Interactive Unconscious Bias Training on Perioperative Learners.

Background: Providers' unconscious biases reinforce health disparities through negative direct patient care and interactions with colleagues. Objective: We created a workshop grounded in Critical Race Theory and the importance of different intersectionalities to improve medical trainees' self-assessment of their implicit biases in curated facilitated spaces. Methods: A total of 44 UCSF first-year clinical anesthesiology residents (CA-1) (95% response rate) and 23 surgery residents in their research year (77% response rate) participated in this workshop over 4 separate sessions in September 2020 and 2021. Quantitative data from a pre-/post-workshop survey was analyzed via a paired t test to evaluate our workshop's effectiveness. Feedback on efficacy was obtained by coding themes from our survey's open-ended questions. Results: The workshop was evaluated positively by a total of 65 of 67 participants in the post-workshop survey. On a 5-point Likert scale, participants self-reported they agreed that their unconscious biases affect their clinical interactions from a pre-workshop mean of 3.3 (SD ± 1.32) to a post-workshop mean of 3.9 (SD ± 0.87, P = .008). Conclusion: Our findings suggest that this workshop was effective for perioperative residents and can be extrapolated to all residents by tailoring the workshop to their respective work environments.

Unprofessionalism in anesthesiology: A qualitative study on classifying unprofessional behavior in anesthesiology residency education.

STUDY OBJECTIVE: This study aims to identify the domains that constitute behaviors perceived to be unprofessional in anesthesiology residency training programs. DESIGN: Qualitative study. SETTING: Anesthesiology residency training programs. PATIENTS: Not applicable. The participants involved residents, fellows, and faculty members purposefully sampled in four US-based anesthesiology residency programs. INTERVENTIONS: Participants were asked to submit examples of unprofessional behavior they witnessed in anesthesiology residents, fellows, or faculty members via a Qualtrics link. MEASUREMENTS: Not applicable. The behavior examples were independently reviewed and categorized into themes using content analysis. MAIN RESULTS: A total of 116 vignettes were collected, resulting in a final list of 111 vignettes after excluding those that did not describe behavior exhibited by anesthesiology faculty or trainees. Fifty-eight vignettes pertained to unprofessional behaviors observed in faculty members and 53 were observed in trainees (residents and fellows). Nine unprofessionalism themes emerged in the analysis. The most common themes were VERBAL, SUPERVISION, QUALITY, ENGAGEMENT, and TIME. As to the distribution of role group (faculty versus trainee) by theme, unprofessional behaviors falling into the categories of BIAS, GOSSIP, LEWD, and VERBAL were observed more in faculty; whereas themes with unprofessional behavior primarily attributed to trainees included ENGAGEMENT, QUALITY, TIME, and SUPERVISION. CONCLUSION: By reviewing reported professionalism-related vignettes within residency training programs, we identified classification descriptors for defining unprofessional behavior specific to anesthesiology residency education. Findings from this study enrich the definition of professionalism as a multi-dimensional competency pertaining to anesthesiology graduate medical education. This framework may facilitate preventative intervention and timely remediation plans for unprofessional behavior in residents and faculty.

Looking Across the Drape: A Novel Quality Improvement Approach to Understanding Surgeon and Anesthesiologist Burnout.

OBJECTIVE: To identify well-being threats for surgeons and anesthesiologists and develop interventions using the Quality of Life Improvement (QOLI) approach. BACKGROUND: Developing feasible perioperative well-being interventions requires identifying shared and specialty-specific well-being needs. The QOLI framework integrates human-centered design, implementation science, and quality improvement to address well-being needs. METHODS: Anesthesia and surgery faculty in eight perioperative departments at an academic medical center completed cross-sectional surveys containing validated measures of well-being and workplace satisfaction, and open-ended questions about professional motivations, pain points, strategies for improvement, and well-being priorities. Using template analysis, we analyzed open-ended survey data and presented resulting themes at a joint-specialty town hall for live-voting to identify well-being priorities. RESULTS: 104 perioperative faculty completed the survey. Across specialties, higher MHC-SF scores (representative of individual global well-being) were associated with higher satisfaction with workplace control, values, decision latitude, and social support. Anesthesiologists reported lower satisfaction and control than surgeons across multiple domains. Template analysis yielded five areas for intervention: (1) Work culture, (2) Work environment/resources, (3) Sources of fulfillment, (4) Work/life harmony, (5) Financial compensation. Surgeons and anesthesiologists both prioritized high-quality patient care but differed in their other top priorities. The most frequently cited well-being threats for surgeons were OR inefficiencies/delays and excessive workload, while anesthesiologists cited understaffing and unpredictable work hours. CONCLUSIONS: Surgeons and anesthesiologists share many needs and priorities, with pain points that are often negatively synergistic. Applying the QOLI approach across specialties allows for well-being interventions that honor complexity and promote the development of feasible solutions.

ChatGPT and Generative Artificial Intelligence for Medical Education: Potential Impact and Opportunity.

ABSTRACT: ChatGPT has ushered in a new era of artificial intelligence (AI) that already has significant consequences for many industries, including health care and education. Generative AI tools, such as ChatGPT, refer to AI that is designed to create or generate new content, such as text, images, or music, from their trained parameters. With free access online and an easy-to-use conversational interface, ChatGPT quickly accumulated more than 100 million users within the first few months of its launch. Recent headlines in the popular press have ignited concerns relevant to medical education over the possible implications of cheating and plagiarism in assessments as well as excitement over new opportunities for learning, assessment, and research. In this Scholarly Perspective, the authors offer insights and recommendations about generative AI for medical educators based on literature review, including the AI literacy framework. The authors provide a definition of generative AI, introduce an AI literacy framework and competencies, and offer considerations for potential impacts and opportunities to optimize integration of generative AI for admissions, learning, assessment, and medical education research to help medical educators navigate and start planning for this new environment. As generative AI tools continue to expand, educators need to increase their AI literacy through education and vigilance around new advances in the technology and serve as stewards of AI literacy to foster social responsibility and ethical awareness around the use of AI.

Engaging GME Learners in Health System-Aligned Improvement Work in the Clinical Learning Environment.

Alignment between graduate medical education (GME) and health system priorities is foundational to meaningful engagement of residents and fellows in systems improvement work within the clinical learning environment. The Residents and Fellows Leading Interprofessional Continuous Improvement Teams program at the University of California San Francisco was designed over a decade ago to address barriers to trainee participation in health system-based improvement work. The program provides structure and support for health system-aligned trainee-led improvement projects in the clinic learning environment. Project champions (residents/fellows) from GME programs attend workshops where they learn improvement methodologies and develop proposals for health system-based improvement projects for their training programs. Proposals are supported by local faculty mentors and are reviewed and approved by GME and health systems' leaders. During the academic year, teams share their progress using visual management boards and interactive leader rounds. The health system provides a modest financial incentive for successful projects. Since the program's inception, thousands of trainees from 58 residency and fellowship programs have participated either as champions or participants in the program at least once, and in total over 300 projects have been implemented. Approximately three-quarters of the specific improvement goals were met, all projects meaningfully engaged residents and fellows, and many projects continued after the learners graduated. This active partnership between GME and a health system created a symbiotic relationship; trainees received education and support to complete improvement projects, while the health system reaped additional benefits from the alignment and impact of the projects. This partnership continues to grow with steady increases in participating programs, spread to partner health systems, and scholarship for trainees and faculty.

The efficacy of an anatomy and ultrasonography workshop on improving residents' confidence and knowledge in regional anesthesia.

BACKGROUND: Ultrasound Guided Regional Anesthesia (UGRA) has become the standard for regional anesthesia practice, but there is not a standardized educational approach for training residents. The objective of this study was to evaluate the efficacy of an UGRA workshop utilizing the theoretical framework of embodied cognition for anesthesiology residents. METHODS: A workshop was developed consisting of didactics, scanning training on standardized patients (SPs) and anatomy reviews on prosected cadavers that focused on the most common UGRA procedures for the upper and lower extremity. At the beginning of the workshop and at the end of the workshop residents completed pre-test and pre-confidence surveys, as well as post-test and post-confidence surveys, respectively to assess the impact of the workshop. RESULTS: 39 residents (100% of the possible residents) participated in the workshop in 2019. Residents' confidence in identifying relevant anatomy for the most common UGRA procedures significantly increased in 13 of the 14 measurements. Residents' knowledge gain was also statistically significant from the pre-test to post-test (20.13 ± 3.61 and 26.13 ± 2.34; p < .0001). The residents found the course overall to be very useful (4.90 ± 0.38) and in particular the cadaveric component was highly rated (4.74 ± 0.55). CONCLUSIONS: In this study, we developed a workshop guided by the embodied cognition framework to aid in shortening the overall learning curve of UGRA for anesthesiology residents. Based on our results this workshop should be replicated by institutions that are hoping to decrease the learning curve associated with UGRA and increase residents' confidence in identifying the relevant anatomy in UGRA nerve blocks.

The fundamentals of Artificial Intelligence in medical education research: AMEE Guide No. 156.

The use of Artificial Intelligence (AI) in medical education has the potential to facilitate complicated tasks and improve efficiency. For example, AI could help automate assessment of written responses, or provide feedback on medical image interpretations with excellent reliability. While applications of AI in learning, instruction, and assessment are growing, further exploration is still required. There exist few conceptual or methodological guides for medical educators wishing to evaluate or engage in AI research. In this guide, we aim to: 1) describe practical considerations involved in reading and conducting studies in medical education using AI, 2) define basic terminology and 3) identify which medical education problems and data are ideally-suited for using AI.

Engagement in Free Open Access Medical Education by US Nephrology Fellows.

BACKGROUND: As free open access medical education (FOAMed) use increases, it is important to characterize how and why learners are using this educational material in nephrology. We describe the frequency, purpose, and type of FOAMed usage across US nephrology fellows. METHODS: In this cross-sectional survey, items were emailed to all US adult and pediatric nephrology fellows via the American Society of Nephrology (ASN) Fellow Survey in May 2022. The eight-item survey, developed to measure FOAMed engagement, had previously undergone instrument validation. The results were analyzed by descriptive statistics. RESULTS: In total, 43% (359/842) adult nephrology fellows and 51% (45/88) pediatric nephrology fellows completed the survey. Seventy-four percent (300/404) of fellows reported using FOAMed, and 72% (215/300) started using FOAMed within the past 2 years. Of FOAMed users, 41% (122/300) reported viewing FOAMed and 33% (99/300) reported applying knowledge gained from these resources daily or weekly. Common purposes for FOAMed engagement included searching Twitter to learn about others' opinions in the field (43%; 130/300), reading blogs to answer clinical questions (35%; 105/300), and listening to podcasts for the most up-to-date information (39%; 116/300). Compared with traditional educational resources, fellows preferred using FOAMed for staying up to date on nephrology topics (75%) and answering clinical questions (37%). Among all fellows, the greatest barriers to FOAMed use were unfamiliarity with FOAMed (27%; 111/404), validity concerns (22%; 90/404), and a lack of a local community of FOAMed users (22%; 87/404). CONCLUSIONS: Seventy-four percent of nephrology fellows used FOAMed resources in a variety of ways, and of them, 33% of fellows clinically applied knowledge gained from these resources. Reasons for engaging with FOAMed varied across resources.

The Consequences of Step 2 Clinical Skills Examination Discontinuation for Medical Schools and Sustainability Plans for Clinical Skills Assessment.

PURPOSE: Comprehensive clinical skills examinations using standardized patients are widely used to assess multiple physician competencies. However, these exams are resource intensive. With the discontinuation of the Step 2 Clinical Skills (CS) exam in 2021, how medical schools will change their approaches to comprehensive clinical skills exams is unknown. This study explores school responses to this change and future directions of comprehensive clinical skills exams using the program sustainability framework. METHOD: This cross-sectional, descriptive study surveyed medical school curriculum deans at 150 Liaison Committee on Medical Education-accredited U.S. medical schools from September to October 2021. The 30-question survey included questions about medical school and participant role, current comprehensive clinical skills exams, sustainability dimensions, and challenges and future directions. Descriptive statistics were used to characterize responses, and content analysis was used to identify themes in the open-ended responses. RESULTS: Educators at 75 of 150 institutions (50%) responded. Sixty-three respondents (84%) reported conducting a comprehensive clinical skills exam. The comprehensive clinical skills exam assessed readiness for graduation (51 [81%]), provided feedback for students (49 [78%]), evaluated curricula (38 [60%]), provided information for medical student performance evaluation or communication with residency (10 [16%]), and assessed other factors (6 [10%]), including preparation for Step 2 CS in the past and readiness for advancement to fourth year of medical school (multiple responses were allowed). Factors facilitating sustainability included sufficient funding to continue the exam (55 [87%]) and the belief that clinical skills assessment in medical school is now more important after discontinuation of the Step 2 CS exam (55 [87%]). Challenges to sustainability included organizational capacity and limited interinstitutional collaboration. CONCLUSIONS: Educators remain committed to the purpose of comprehensive clinical skills exams. Adapting to changed licensing requirements while sustaining clinical skills exams enables innovation and improvement in assessment of clinical competence.

Students' Perspectives on Basic and Clinical Science Integration When Step 1 is Administered After the Core Clerkships.

Phenomenon: According to adult learning theories, effective cognitive integration of basic and clinical science may promote the transfer of knowledge to patient care. The placement of the U.S. Medical Licensing Examination (USMLE) Step 1 after the core clerkships is one strategy intended to facilitate cognitive integration, though learner experiences with this model are unexplored. The purpose of this study is to understand students' perspectives on basic and clinical science integration in a post-clerkship Step 1 curriculum. Approach: Focus groups were conducted between August and September 2020 with senior medical students from the University of California, San Francisco School of Medicine and University of Michigan Medical School. Data were analyzed using a constructivist approach to thematic analysis. Findings: Thirty-three students participated in six focus groups. Participants described multiple barriers to cognitive integration in the clerkship learning environment, though they also identified examples of teaching and learning that facilitated integration. Early in their clerkships, students struggled to integrate because of their tenuous basic science foundation, cognitive overload, and difficulty perceiving the relevance of basic science to patient care. They felt that educators primarily focused on clinical science, and many basic science teaching sessions during clerkships felt irrelevant to patient care. However, students also described experiences that made the connection between basic and clinical science more explicit, including modeling by educators and clerkship learning activities that more overtly encouraged the application of basic science to clinical care. In addition, the return to basic science studying during the post-clerkship dedicated Step 1 study period offered powerful integration opportunities. These facilitators of cognitive integration helped students recognize the value of integration for enduring learning. Insights: There are myriad barriers to cognitive integration of basic and clinical science during clerkships in a post-clerkship Step 1 curriculum. The relevance of basic science to patient care needs to be made more explicit to students through modeling by clinician educators to augment the potential benefits of curricular change. The post-clerkship Step 1 study period appears to offer a unique opportunity for cognitive integration later in a learner's trajectory that may be related to curricular design. When learners recognize the applicability of basic science to patient care, they may more intentionally transfer basic science knowledge to clinical practice.

Drivers of Well-Being and Burnout in Anesthesiology Residents.

Background: With more than 50% of anesthesiology residents reporting burnout, many residency programs have begun creating wellness programs to address burnout and promote well-being. However, to date, many wellness initiatives have focused on individual strategies rather than systems approaches to improve the learning environment. Individual-focused interventions in the absence of systematic efforts can lead to resentment, resistance, and worsening burnout and precipitate a loss of trust in leadership and the organization. Here, we describe a process to engage anesthesiology residents, who are key stakeholders, by exploring their perspectives on burnout and well-being to better inform systematic interventions to improve the clinical work and learning environments. Methods: We conducted semistructured interviews with second- and third-year clinical anesthesia residents at the University of California, San Francisco, using the areas of worklife model as sensitizing concepts. We conducted a thematic analysis on transcribed interviews grounded in constructivist orientation. Results: We identified the following 3 major categories of themes based on interviews with 10 residents: (1) definition of well-being, (2) challenges to well-being, and (3) strategies for coping with challenges and burnout. Challenges described by anesthesiology residents align with the areas of the worklife model, with the coronavirus disease 2019 pandemic precipitating additional threats in the domains of workload and community. Conclusions: Anesthesiology residents' definition of well-being includes both individual (resilience) and systemic (meaning in work, job autonomy, and control) factors, reaffirming that positive work and learning environments are critical to professional well-being.

Residents' Challenges in Transitioning to Residency and Recommended Strategies for Improvement.

Background: The transition from internship to residency can be a particularly stressful time for learners, adversely affecting residents' experience of training. Despite awareness of residents' stress during transitions, there is limited information available regarding how residents perceive these transitions or how they could be improved. We explored residents' accounts of the experience of transitioning from internship to residency to develop a better understanding of their challenges and recommended strategies for interventions. Methods: We conducted semistructured interviews with first-year anesthesia residents at the University of California, San Francisco. We conducted a thematic analysis through a general inductive approach on transcribed interviews. Results: Ten residents, evenly split among categorical and noncategorical residents, participated in the interviews. We identified seven challenges faced by residents during the transition, including cognitive load management, self-assessment and eliciting effective feedback, learning resource utilization, preoperative care planning and discussion, forming relationships with peers and faculty, and professional identity formation. Residents also recommended strategies to address these challenges, including early low-stake exposure to complex cases, standardized feedback structure, resource utilization guides, normalization of discussing errors with peers, and protected time for networking events. Conclusion: Residents face multiple challenges at the personal, social, and structural levels during the transition. Their recommended strategies are actionable, including scaffolded learning opportunities with increasing difficulty, more standardized and structured communications around expectations and effective feedback, enhanced orientation through bootcamp, and integration of more formal and informal social networking opportunities to increase peer and faculty interaction.

Profiles for Success: Examining the Relationship between Student Profiles and Clerkship Performance Using Latent Profile Analysis.

PHENOMENON: Learning is a complex phenomenon in which learners can vary in their learning orientation, learning approaches, and perception of the learning environment. Learners may be characterized as mastery oriented or performance oriented, and this learning orientation can influence their learning approaches, such as whether to seek feedback or ask for help. The learning environment includes institutional assessment policies and informal interactions that emphasize outcomes and differentiation among students. When learners perceive the learning environment as performance oriented, they feel competition from other learners and fear negative feedback. This complex interplay of learning orientation, its influence on feedback-seeking behavior, and the environmental influence and reinforcement of both can be captured through learner profiles. APPROACH: In this multi-institutional cross-sectional survey study of students from six U.S. medical schools, we investigated learner profiles that characterize how these domains manifest together across individual learners. We then determined how these profiles are associated with students' clerkship grades. Measures included the Patterns of Adaptive Learning for learning orientation, self-reports for learning approaches, and perceptions of the learning environment. We used latent profile analysis to cluster students who share common characteristics around orientation, behavior, and environment. The relationship between these profiles and the percentage of honors earned was examined using multiple regression analysis. FINDINGS: We found four distinct learner profiles within 666 of 974 (68%) analyzable responses: (1) performance oriented with negative perceptions of environment, (2) mastery oriented with desirable learning approaches, (3) "average" group, and (4) mastery orientation only. Profile 1 (M = 39%) and Profile 4 (M = 38%) students received fewer clerkship honors compared with other profiles. Profile 2 students earned a significantly higher percentage of honors grades (M = 54%) compared with other students. Profile 3 students (average group) earned the second highest percentage of honors (M = 46%). Effect sizes comparing the percentage of honors varied from 0.32 to 0.65, indicating medium to large differences. INSIGHTS: The highest performers, as measured by clerkship honors grades, were mastery oriented, perceived a more positive learning environment, and were comfortable asking questions and seeking feedback for their learning. The lowest performing students were performance oriented and had negative perceptions of their learning environments. Contrary to previous findings, we found that the relationship between mastery orientation and learning approaches is not unidirectional but rather seems to be mediated by perceptions of the learning environment.

A Call to Action From the California Consortium for the Assessment of Clinical Competence: Making the Case for Regional Collaboration.

The discontinuation of the United States Medical Licensing Examination Step 2 Clinical Skills Examination emphasizes the need for other reliable standardized assessments of medical student clinical skills. For 30 years, the California Consortium for the Assessment of Clinical Competence (CCACC) has collaborated in the development of clinical skills assessments and has become a valuable resource for clinicians, standardized patient educators, psychometricians, and medical educators. There are many merits to strong multi-institutional partnerships, including the integration of data across multiple schools to provide feedback to both students and curricula, pooled test performance statistics for analysis and quality assurance, shared best practices and resources, individual professional development, and opportunities for research and scholarship. The infrastructure of the CCACC allows member schools to adapt to a changing medical landscape, from emerging trends in clinical medicine to the limitations imposed by a global pandemic. In the absence of a national examination, there is now a greater need for all medical schools to develop a comprehensive, dynamic, and psychometrically sound assessment that accurately evaluates clinical skills. Medical schools working together in regional consortia have the opportunity to create and implement innovative and robust assessments that evaluate a wide range of clinical skills, ensure that medical students have met an expected level of clinical competency before graduation, and provide a framework that contributes to ongoing efforts for the development of new national clinical skills standards.

Development and validation of the safe transfusion assessment tool.

BACKGROUND: Given the prevalence and risks of blood transfusion, it is essential that trainees and practicing clinicians have a thorough understanding of relevant transfusion medicine competencies. The aim of this research was to develop and gather validity evidence for an instrument to assess knowledge of core transfusion-related competencies. METHODS: We developed the safe transfusion assessment tool (STAT) using a multistep process. Initially, 20 core competencies in transfusion medicine were identified through a consensus-driven Delphi process. Learning objectives and assessment items pertinent to each competency were created. Next, a 13-item assessment tool was piloted with multidisciplinary experts and trainees. Multiple iterative revisions were made based on feedback. Finally, the 12-item STAT was administered to 100 participants of varying training level and specialty to establish validity, difficulty and item discrimination indices, and perceived utility. RESULTS: Analysis of instrument item difficulty and item discrimination indices demonstrated the ability of the STAT to assess essential knowledge in transfusion medicine relevant to trainees and clinicians in multiple programs and practice settings. Eight of twelve items discriminated between learners with varying degrees of expertise. Hundred percent of students and trainees rated the STAT as Extremely Helpful or Somewhat Helpful and the majority planned to utilize the answer guide as a study aid. CONCLUSION: The STAT is a concise, valid, and reliable knowledge assessment tool that may be used by researchers and educators to augment transfusion medicine curricula (www.safetransfusion.ucsf.edu). Scores can help inform departments on areas in which trainees require additional support and areas of potential educational interventions.

Validity evidence for flourishing as a measure of global wellbeing: a national multicenter study of academic general surgery residents.

Purpose: Physician wellbeing is critical to high-quality sustainable healthcare and optimal patient experience. Few objective measures exist to assay wellbeing (as opposed to just pathology) in surgery, or to evaluate the efficacy of wellbeing interventions. Flourishing (as measured by the Mental Health Continuum, MHC) has been suggested as a concise measure of global wellbeing in surgeons. We aimed to establish validity evidence for flourishing in a large national sample of surgical trainees, explore differences by gender and race, and confirm support for the underlying constructs. Methods: This cross-sectional study of all General Surgery residents at 16 ACGME-accredited academic programs included an online survey of published measures distributed in February 2021. The Mental Health Continuum (MHC), a three-factor model, assesses emotional, social, and psychological wellbeing and is an established metric of psychosocial thriving in non-physicians. A global score cut-off exists for flourishing which represents high wellbeing. Correlation between flourishing and established measures of risk and resilience in surgery were assessed for validity evidence. Differences by gender and race were explored. A confirmatory factor analysis (CFA) was performed to confirm the three-factor structure in surgical trainees. Results: 300 residents (60% non-male, 41% non-white) responded to the survey. For the overall group, flourishing was significantly positively correlated with all wellbeing resilience factors and negatively correlated with all risk factors. This held true for race and gender subgroups based on interaction analyses. CFA and sensitivity analysis results supported the three-factor structure. Conclusions: Our findings offer validity evidence for flourishing as a measure of global wellbeing and confirm the three-factor structure of emotional, social, and psychological wellbeing in surgical trainees. Thus, the MHC may be a concise tool for assaying wellbeing, within and across subgroups, and for assessing wellbeing intervention effectiveness within the surgery.

Conflict Management Education for Anesthesiology Residents: Bridging the Gap in Interpersonal and Communication Skills Competency.

Effective communication and conflict management are important skills for anesthesiologists and are designated by the Accreditation Council for Graduate Medical Education (ACGME) as elements of the "interpersonal and communication skill" competency (ACGME Anesthesiology Milestone Project 2020). However, structured conflict management education for anesthesiology residents remains limited. To address this gap, we developed and implemented a conflict management session incorporating didactics and application exercises using role-play and high-fidelity simulation (SIM) for anesthesiology residents (postgraduate years 3 and 4) at a tertiary academic medical institution. These sessions were well-received, and both role-play and SIM appear to help residents learn conflict management skills.