Evaluating students' research literacy knowledge, confidence, and attitudes at the beginning and end of a doctor of chiropractic program.

OBJECTIVE: The doctor of chiropractic program (DCP) graduate must demonstrate competency in clinical research literacy (CRL), per accreditation standards. This study aimed to compare student CRL knowledge, confidence, and attitudes between the beginning and end of their DCP. METHODS: We collected data on 245 matriculating students' CRL knowledge, confidence, and attitudes between 2017 and 2018. In 2021 and 2022, 78 of these students enrolled in a course with an extra credit assignment that was used to re-collect CRL data as they approached graduation. We assessed changes between entry and exit using statistical analyses in STATA17. RESULTS: Paired data were collected for 56 students. The mean CRL scores on a scale of 10 at the DCP beginning and end were 5.25 (SD 2.06) and 6.54 (SD 1.89), respectively (p = .0001). We observed statistically significant (p ≤ .05) positive changes in students' abilities to answer questions about Medical Subject Headings, the hierarchy of evidence, systematic reviews, meta-analyses, and the limitations of abstracts. There was also a statistically significant increase in confidence, with over 80% of students nearing graduation reporting good or excellent abilities to find and judge health information for their patients. The proportion of students who envisioned searching a database to help manage a challenging clinical case decreased from 96% to 89% (p > .05). The proportion seeing themselves submitting a case report for publication declined from 16% to 4% (p ≤ .05). CONCLUSION: Students' self-perceived CRL abilities and knowledge improved between the beginning and end of their DCP; however, their attitudes toward applying these in practice declined.

Chiropractic faculty experiences of burnout and the COVID-19 pandemic.

OBJECTIVE: The Maslach Burnout Inventory (MBI) is frequently used to assess occupational burnout and the Epidemic-Pandemic Impacts Inventory (EPII) is a new tool for assessing pandemic impacts. This study's objective is to describe chiropractic faculty members' experience of the COVID-19 pandemic, their burnout as professional educators, and their strategies for coping with stress. METHODS: A Qualtrics survey link was emailed to 73 current faculty and 10 previously employed faculty from 1 chiropractic school. The survey included 22 MBI, 31 EPII, and 2 questions about coping strategies. Faculty were given several weeks to complete the survey, were reminded via emails and meeting announcements, and were given paper surveys to increase participation. Responses were analyzed in STATA17. RESULTS: Forty-three faculty completed the survey (response rate = 52%). Of these, 25.8% reported testing positive for COVID-19, 30.23% reported difficulties transitioning to working from home, and 25.5% scored high on the MBI subscale for emotional exhaustion (EE) (mean 15.79, SD 13.68). Higher EE was associated with pandemic-related increases in mental health and sleep problems. Common coping strategies included self-care and social support. CONCLUSION: The majority of faculty reported neither contracting COVID-19 nor having difficulty transitioning to work from home. Average EE for participating faculty was lower than previous reports although a quarter scored high in EE, which may be associated with pandemic-related mental health and sleep problems. These results suggest chiropractic faculty might need support coming out of the COVID-19 pandemic and indicate the need for future research on burnout among faculty from other chiropractic institutions.

Snakebite prevalence and risk factors in a nomadic population in Samburu County, Kenya: A community-based survey.

INTRODUCTION: Snakebite is an important public health concern, especially in tropical areas, but the true burden remains unclear due to sub-optimal reporting and over-reliance on health facility-based data. METHODS: A community-based cross-sectional survey was conducted in Samburu County, Kenya from December 2019 to March 2020. Geospatial techniques were used to create a sampling frame of all households in Samburu County and a multistage cluster sampling strategy to select households and recruit study participants. Five year prevalence and mortality rates were estimated, the characteristics and circumstances of snakebite were described, and multilevel logistic regression models were built to identify independent risk factors for snakebite. RESULTS: We recruited 3,610 individuals living in 875 households from 30 clusters. The 5-year prevalence of snakebite was 2.2% (95% CI 1.4%-3.4%), and the 5-year mortality rate was 138 (95% CI 44-322) deaths per 100,000 inhabitants, resulting in an estimated 1,406 snakebites and 88 deaths from snakebites per year in Samburu County. Snakebite incidents often occurred at night between 9pm and 6 am (44%, n = 36), and the participants were mostly walking/playing outdoors (51%, n = 41) or sleeping (32%, n = 27) when they were bitten. Lower household socioeconomic status and smaller numbers of people per house were significant independent risk factors. CONCLUSION: Samburu County has a high snakebite burden and the most victims are bitten while sleeping or walking outdoors at night. Snakebite prevention and health promotion programs in Samburu County, and other endemic regions, need to be contextualised and consider the geographic, seasonal, and temporal specificities found in our study. Our findings also have implications for health care delivery, especially identification of the need for night-time staffing with expertise in snakebite management and antivenom availability to better manage patients and thereby improve outcomes.

Conducting epidemiological studies on snakebite in nomadic populations: A methodological paper.

INTRODUCTION: Research on snakebite has mostly been conducted on settled populations and current risk factors and potential interventions are therefore most suited for these populations. There is limited epidemiological data on mobile and nomadic populations, who may have a higher risk of snakebite. METHODS AND RESULTS: We conducted a scoping review to gather evidence on survey methods used in nomadic populations and compared them with contemporary survey methods used for snakebite research. Only 16 (10.5%) of 154 articles reportedly conducted on pastoralist nomadic populations actually involved mobile pastoralists. All articles describing snakebite surveys (n = 18) used multistage cluster designs on population census sampling frames, which would not be appropriate for nomadic populations. We used geospatial techniques and open-source high-resolution satellite images to create a digital sampling frame of 50,707 households and used a multistage sampling strategy to survey nomadic and semi-nomadic populations in Samburu County, Kenya. From a sample of 900 geo-located households, we correctly identified and collected data from 573 (65.4%) households, of which 409 were in their original locations and 164 had moved within 5km of their original locations. We randomly sampled 302 (34.6%) households to replace completely abandoned and untraceable households. CONCLUSION: Highly mobile populations require specific considerations in selecting or creating sampling frames and sampling units for epidemiological research. Snakebite risk has a strong spatial component and using census-based sampling frames would be inappropriate in nomadic populations. We propose using open-source satellite imaging and geographic information systems to improve the conduct of epidemiological research in these populations.

"It's the most important work we will ever do": Chiropractic students, servicelearning experiences at a day laborer center in California.

OBJECTIVE: From 2009 to 2019, staff, students, and faculty volunteers from a chiropractic college started Mission Trip America, later re-named Service Trip America (STA), providing monthly free chiropractic services at a hiring hall for day laborers in San Francisco until the 2020 COVID-19 hiatus. We report on volunteers' service-learning experiences. METHODS: Mixed-methods analysis comprising document review, descriptive report of site visit records, and thematic analysis of semi-structured interviews with 12 student and faculty volunteers. RESULTS: STA conducted 104 visits (8-11 per year) including 2272 patient encounters. Document review revealed an average of 22 patients per visit, with 60% to 85% return patients. On average, 3 student interns and 2 student assistants attended each visit, supervised by a doctor of chiropractic faculty member and the program director. Most commonly, interns treated 8 patients during the 4- to 5-hour visits. Patient concerns included musculoskeletal problems and other health conditions commonly seen at chiropractic offices and teaching clinics. Interns also regularly saw chronic health problems exacerbated by poor living conditions, violence, limited access to health care, low educational attainment, chronic stress, and the extreme biomechanical loading resulting from heavy labor. Interview results yielded 4 themes: learning, attitudes, challenges, and program strengths. Interviewees described opportunities to learn while working with a marginalized population and discussed long-term effects on their postgraduation practice as chiropractors. CONCLUSION: Patients' physical, mental health, and psychosocial issues illustrated unique circumstances and profound needs of the underserved population being cared for by STA volunteers. Our findings may provide guidance for other community-based chiropractic service-learning programs in marginalized and underserved communities.

Information literacy of matriculating chiropractic students assessed via research readiness survey.

OBJECTIVE: We developed a Research Readiness Survey (RRS) to identify students' information literacy needs prior to instruction by a team of faculty members and librarians in our doctor of chiropractic program clinical research literacy courses. In addition to describing students' responses to our RRS, we explored associations between (1) students' overall performance on the RRS and their prior earned degrees and (2) their self-reported ability and performance on questions pertaining to evaluating information quality (standard 3 of the Association of College and Research Libraries [ACRL] Information Literacy Competency Standards for Higher Education). METHODS: The RRS is composed of 50 questions, of which 22 pertain to information literacy knowledge assessment per ACRL standards. We calculated means and standard deviations for summary scores on 4 ACRL standards and for a total RRS score. We used analysis of variance to assess whether standard 3 scores differed by students' self-reported ability to judge health information quality and whether there was an association between total RRS scores and students' previously earned degrees. RESULTS: In 2017-2018, 245 students (70% of matriculates) completed the RRS. Students performed best on standard 3 (average score 67%) and worst on standard 2, the ability to access information (average score = 59%). Students who reported an average ability to judge information quality had higher standard 3 scores than students who reported poor ability (p = .003). Students with bachelor's degrees had higher total RRS scores than students with associate's degrees (p = .004). CONCLUSION: Matriculating students had the most difficulty with accessing information, supporting the need to include librarians on the teaching team.

Mental health and lifestyle behaviors of students in a doctor of chiropractic program.

OBJECTIVE: Health professional students' mental health and lifestyle behaviors may impact their personal health as well as their clinical practice. The objective of our retrospective study was to see if there were changes in students' mental health and lifestyle behaviors during their doctor of chiropractic program (DCP). METHODS: In 2019, we identified health center files for 198 students who graduated from our DCP between 2015 and 2016, of which 69% (n = 137) contained Health Insurance Portability and Accountability Act (HIPAA) consent forms granting permission for file review. From each of these files, we extracted mental health and lifestyle behavior data that students self-reported at the beginning and end of their DCP. Data were analyzed with descriptive statistics, paired t test, sign test, and McNemar's chi-square test. RESULTS: The majority of our students reported drinking alcohol, engaging in regular exercise, and not smoking at the beginning and end of our DCP. Comparing pre and post data, there was a statistically significant increase in water, fruit, and vegetable consumption along with an increased proportion of students reporting eating junk food and drinking 1 or more servings of caffeine (p ≤ .002). The proportion of students reporting anxiety or depression decreased between the beginning and end of our DCP (p = .002). CONCLUSION: This study provided information about student mental health and lifestyle behaviors at 1 DCP. We recommend future studies use validated questionnaires across multiple DCPs. There also may be a need for intervention research to decrease DCP student alcohol use.

Perceptions of Older Adults with Hematological Cancer on Diet and Exercise Behavior and Its Role in Navigating Daily Tasks.

Diet and exercise are associated with the maintenance of physical function, independence and better health-related quality of life in cancer survivors. Adherence to healthy diet and exercise guidelines, however, remains low. The aim of this study was to explore the perceptions of hematological cancer survivors (HCS, ≥50 years) on the role of diet and exercise in navigating daily tasks using a qualitative descriptive research method. Eligible HCS completed an online survey gathering demographic information including physical functioning, exercise frequency, malnutrition and frailty risk. Following a semi-structured telephone interview, thematic analysis was used. Nine HCS (67 ± 2 years) were included in the final analysis, with 55.5% sufficiently active, three at risk of malnutrition and five of frailty. Three primary themes reflected the survivors' perceptions: (1) beliefs about the impact of diet and exercise on physical and mental wellbeing, (2) the ability to overcome barriers to adhere to healthy diet and exercise behavior, and (3) diet and exercise empowered and gave hope. Participants had a more nuanced understanding of the role of exercise in physical function but lacked insight into the role of a healthy diet. Knowledge, support and instruction were key enablers of diet and exercise behavior, with community connection a unique enabler identified in this group.

Association Between Chiropractic Utilization and Opioid Prescriptions Among People With Back or Neck Pain: Evaluation of the Medical Expenditure Panel Survey.

OBJECTIVE: The purpose of this study was to assess the association between patients in the United States seeing a chiropractor and receiving an opioid prescription for back or neck pain. METHODS: Medical Expenditure Panel Survey (Years 2012 to 2015) respondents for longitudinal panels 17 to 19 who participated in all 5 rounds were at least 18 years of age, did not have cancer, and reported back or neck pain. We defined chiropractic users as participants reporting at least 1 chiropractic visit for back or neck pain and opioid users as participants reporting purchase or receipt of a prescription classified as Multum Lexicon "60" and "191" for back or neck pain. We adjusted for socioeconomic and clinical variables using multiple logistic regression. RESULTS: The sample contained 4686 people, 21% of whom reported an opioid prescription for back or neck pain. Among opioid users, 14% reported a chiropractic visit for back or neck pain compared to 31% of nonopioid users. The adjusted odds ratio for chiropractic use among opioid users compared to nonopioid users was 0.46 (95% confidence interval, 0.36-0.57). CONCLUSION: Patients with back or neck pain who saw a chiropractor had approximately half the odds of reporting an opioid prescription compared to those who did not see a chiropractor.

Education and patient care in a chiropractic teaching clinic: An organizational approach to health and safety during the COVID-19 pandemic.

OBJECTIVE: The academic teaching clinic at our chiropractic college in California remained open beginning in the early stages of the COVID-19 pandemic and shelter-in-place order requiring individuals to stay at home except for essential activities. We report the experiences described by health center personnel who were present during the shelter-in-place early stages. METHODS: Narrative approach and descriptive thematic analysis of transcripts of 15 interviews with faculty, staff, and student interns. Report of key events and processes for developing ongoing COVID-related policies and procedures to conform with state and county public health mandates. RESULTS: Themes included (1) Organizational processes and procedures; (2) Perceptions of safety; (3) Successful adaptations and responses; (4) Challenges; (5) Mental health and well-being; (6) Unanticipated benefits and opportunities; and (7) Reflections on chiropractic philosophy. Participants' initial fears diminished as they gained confidence in the safety conferred by the new procedures and a returning sense of normalcy. They discussed the importance of social connection, chiropractic wellness philosophy, and their personal beliefs within the context of the pandemic and public health mandates. Despite initial reductions in numbers of patients and procedures that could be performed, patients received continuing chiropractic care and interns were able to complete their academic requirements while experiencing unique learning opportunities. CONCLUSION: Despite substantial challenges, the rapid response in the early stages of the pandemic enabled the college to fulfill the multiple missions of providing patient care, community support, and uninterrupted clinical education to student interns while conforming to public health mandates and guidelines.

Adverse childhood experiences and cognitive disability in the 2019 United States behavioral risk factor surveillance system.

A growing number of studies have found associations between adverse childhood experiences (ACEs) and adult well-being, with disparities between subpopulations. Limited research exists about the association between ACEs and cognitive disability, and variations by race and ethnicity. This study reports a cross-sectional analysis of 2019 Behavioral Risk Factor Surveillance System (BRFSS) data (n = 93 692) conducted in 2021. Logistic regression models examined the association between ACEs and cognitive disability (as defined by serious difficulty concentrating, remembering or making decisions because of a physical, mental, or emotional condition) and whether the association varied by race and ethnicity, adjusting for demographics, (age, gender, marital status), socioeconomic factors (income and education), and perceived general health. Exposures to 1, 2, 3, and 4 or more ACEs were associated with elevated odds of cognitive disability; the association varied by race and ethnicity (p for interaction less than 0.05). In stratified analyses, ACEs were positively associated with cognitive disability among the American Indian/Alaskan Native group, though significant only among those reporting 4 ACEs or more (OR: 2.89; 95% CI 1.25, 6.66). A dose response was observed for Black, White and Hispanic groups though the association was larger among Hispanic respondents. The elevated odds of cognitive disability associated with ACEs warrant additional research to understand mechanisms underlying this relationship across racial and ethnic groups. Additionally, interventions to prevent cognitive disability may benefit from considering ACEs across all populations, particularly among those with highest prevalence.

Improved Time in Therapeutic Range with International Normalized Ratio Remote Monitoring for Patients with Left Ventricular Assist Devices.

Despite advances in therapy, bleeding and thromboembolic events are frequent complications in patients with left ventricular assist device (LVAD) support. Maintaining warfarin in therapeutic range has been shown to be more challenging in this patient population compared to other indications. Patients with LVADs on warfarin typically are within goal international normalized ratio (INR) range 36-57% of the time, compared to about 65% for other indications. The goal of this study was to evaluate if an INR remote monitoring system along with the implementation of a standardized warfarin management protocol improves warfarin time in therapeutic range (TTR) for patients with LVADs. This single-center, retrospective, observational study included 78 patients with LVADs that were followed at our academic center from January 2015 to October 2017. In October 2016, we updated our warfarin management protocol and implemented a remote monitoring system with patients' weekly INR results monitored. The primary objective of the study was to determine the difference between TTRs in remote monitoring versus standard monitoring. We found that the average TTR was significantly higher in the remote monitoring group compared to the standard monitoring cohort (61.1% vs. 40.0%, p < 0.005). However, bleeding, thrombotic incidence, and hospital readmission rates were similar between the two patient cohorts. Remote monitoring improved warfarin TTR significantly in this study and may have the potential to improve anticoagulation-related outcomes in patients with LVADs.

Experiences and perspectives of chiropractic students graduating from an alternate admission track plan.

OBJECTIVE: This study explored self-reported experiences of alternate admission track plan (AATP) students who completed a chiropractic training program at a US chiropractic college. METHODS: Our institution conducted semistructured exit interviews with 16 graduating AATP students. Our consensus-drafted open-ended interview questions probed in-depth for these students' experience throughout the training program, with national board exams, their personal characteristics, their satisfaction with the training program generally, and with the AATP program specifically. We employed a content analysis to identify themes and patterns of responses across the blinded deidentified interview transcripts. We used a combination of deductive coding based on our interview guides, and inductive coding to identify newly emerging subthemes. RESULTS: Perceived facilitators of student success were strong commitment to chiropractic, cooperative, and supportive environment (eg, student study groups and a highly committed faculty), work ethic, and time management skills. Although many recommended that AATP entrants without science backgrounds take prerequisite courses in biology and chemistry, they also observed that a capable student could dedicate the time and effort to obtain the needed information via available college resources. CONCLUSION: Graduating AATP students were positive about the AATP program overall, and their preparation for national board exams and for clinical practice. They greatly valued the opportunity to accelerate their entrance into chiropractic college. A major limitation of this study is that the perspectives of AATP students who did not complete the doctor of chiropractic program are not represented in these interviews of graduating students.

Safety, Tolerability, and Pharmacokinetics of High-Volume Subcutaneous Crenezumab, With and Without Recombinant Human Hyaluronidase in Healthy Volunteers.

Compared with intravenous formulations, subcutaneous (s.c.) formulations of therapeutic monoclonal antibodies may provide increased patient access and more convenient administration options, although historically high-volume s.c. administration (> 10-15 mL) has been challenging. We report results from two phase I studies in healthy participants (GP29523 and GP40201) that evaluated s.c. crenezumab, an anti-Aß monoclonal antibody in development for individuals at risk for autosomal-dominant Alzheimer's disease. GP29523 assessed safety, tolerability, and pharmacokinetics (PK) in 68 participants (aged 50-80 years) who received single ascending doses (600-7,200 mg) of crenezumab or placebo (4-40 mL). GP40201 assessed safety, tolerability, and PK in 72 participants (aged 18-80 years) who received different combinations of dose (1,700-6,800 mg), infusion volume (10-40 mL), and flow rate (2-4 mL/minute), with/without recombinant human hyaluronidase (rHuPH20). There were no serious or dose-limiting adverse events in either study. There were no meaningful differences in pain scores among reference placebo (4 mL), test placebo (4-40 mL), or crenezumab (600-7,200 mg) in GP29523, or across treatments with varying infusion volume, flow rate, dose, or rHuPH20 co-administration or concentration in GP40201. Transient erythema was the most common infusion site reaction in both studies. In GP40201 at volumes of ≥ 20 mL, rHuPH20 co-administration appeared to reduce infusion site swelling incidence, but, in some cases, was associated with larger areas of infusion site erythema. Crenezumab exhibited approximately dose-proportional PK, and s.c. bioavailability was 66% and independent of dose or rHuPH20 co-administration. High-dose, high-concentration, high-volume s.c. crenezumab formulated with/without rHuPH20 was well-tolerated in healthy participants, with an acceptable safety profile.

Evaluating a service-learning assignment in a doctor of chiropractic program public health course.

OBJECTIVE: Despite the use of service learning in other health care education programs, little is published about its use in doctor of chiropractic programs. Since 2017, the public health course at our institution has included a service-learning assignment in which students volunteer for nonprofit organizations and write an essay about their experience. The objective of this study was to assess the effects of the assignment on students' self-reported public health knowledge and attitudes. METHODS: Between April 2017 and June 2018, 56 essays were collected from students who volunteered at a nonprofit organization focused on 3 categories: youth, the environment, or poverty. Each essay was deidentified and assigned random 4-digit-number file names. Ten files were randomly selected from each of the 3 categories for qualitative thematic analysis using deductive and inductive coding. RESULTS: Student essays demonstrated competency in public health concepts, including organizational systems, levels of prevention, and the social ecological model. In addition, a majority of the students went beyond discussing knowledge gained from this assignment and described the impact of their experience on their personal growth. CONCLUSION: This study demonstrates that students respond favorably to a service-learning assignment that addresses public health competencies and may foster personal and professional development.

What is the long-term outlook for young people following liver transplant? A single-centre retrospective analysis of physical and psychosocial outcomes.

LT is a successful treatment for end-stage liver disease. The long-term outcome of patients transplanted in childhood has not previously been widely reported. This project assessed the long-term impact of transplantation in patients surviving >15 years. Retrospective data on growth, end-organ damage and psychosocial development were collected in young people transplanted from 1985 to 2000 in a single centre. Clinical notes were reviewed, and patients interviewed at clinic follow-up. 224 patients were transplanted between 1985 and 2000. 143 recipients (63.8%) survived >15 years with a median survival of 19.52 years. The majority were well, and only 10% had abnormal graft function (biochemical/synthetic), the main cause of which was chronic hepatitis (6%). Renal dysfunction and the necessity for renal transplant were identified in 32.8%, of whom 16.7% of patients had a cGFR <70 mL/min/1.73 m2 and 6% of patients had either undergone or awaiting renal transplant. This cohort was healthier than the average age-matched UK population in terms of body mass index (9% obese), smoking and alcohol consumption. 92% of patients had completed or were in education (93/123 had completed education and 20/123 remained in school). 63.7% of patients had been transitioned into adult services, and 46.3% of these patients were employed. 67.5% were in a relationship, one patient was divorced, and 10.6% of patients had one or more children. 11 patients had symptoms that corresponded to a DSM IV diagnosis of depression. Four patients had anorexia nervosa. Developmental delay was identified in 9 out of 99 patients. The development of malignancy, including PTLD, occurred in 10/143 (7%) patients at a median time post-transplant of 2.76 years (range 0.76-9.06 years). Epstein-Barr infection was implicated in 75% of these malignancies. We conclude the long-term outcome of LT in childhood is good with 63.8% surviving into adulthood and over 60% transferring into adult services. Graft dysfunction and end organ damage are minimal. Our cohort is healthier than the general population, and the majority have completed education, sought employment and formed relationships with peers, contributing well to society.

Development of a student grading rubric and testing for interrater agreement in a doctor of chiropractic competency program.

OBJECTIVE: Clinical competency is integral to the doctor of chiropractic program and is dictated by the Council of Chiropractic Education accreditation standards. These meta-competencies, achieved through open-ended tasks, can be challenging for interrater agreement among multiple graders. We developed and tested interrater agreement of a newly created analytic rubric for a clinical case-based education program. METHODS: Clinical educators and research staff collaborated on rubric development and testing over four phases. Phase 1 tailored existing institutional rubrics to the new clinical case-based program using a 4-level scale of proficiency. Phase 2 tested the performance of the pilot rubric using 16 senior intern assessments graded by four instructors using pre-established grading keys. Phases 3 and 4 refined and retested rubric versions 1 and 2 on 16 and 14 assessments, respectively. RESULTS: Exact, adjacent, and pass/fail agreements between six pairs of graders were reported. The pilot rubric achieved 46% average exact, 80% average adjacent, and 63% pass/fail agreements. Rubric version 1 yielded 49% average exact, 86% average adjacent, and 70% pass/fail agreements. Rubric version 2 yielded 60% average exact, 93% average adjacent, and 81% pass/fail agreements. CONCLUSION: Our results are similar to those of other rubric interrater reliability studies. Interrater reliability improved with later versions of the rubric likely attributable to rater learning and rubric improvement. Future studies should focus on concurrent validity and comparison of student performance with grade point average and national board scores.

Parents as Teachers: Teaching Pediatrics Residents the Art of Engaging in Difficult Conversations.

BACKGROUND: Physicians often lack the skills and confidence needed to have difficult conversations with patients and their families. Patients and families who have experienced these conversations can provide valuable insight for resident physicians. OBJECTIVE: We developed a communication skills workshop for pediatrics residents using parents and a team of social workers, nurses, chaplains, and physician facilitators in role-playing exercises. METHODS: From 2007 to 2016, half-day "difficult conversation" workshops were held annually for postgraduate year 1 (PGY-1) and PGY-2 residents that included an interprofessional team and parents of children with life-threatening diagnoses. Questionnaires assessed residents' prior training, effectiveness of the sessions, and narrative feedback on the impact of this approach. Parents and team members were surveyed on the effectiveness of the training and the value of parent involvement. RESULTS: Median self-reported confidence levels for incoming PGY-1 residents following the workshop rose from 2 to 4 on a 5-point Likert scale (99% response rate [128 of 129 surveyed], P < .001). The majority of PGY-2 residents (91%, 115 of 126) reported the workshop increased their confidence in engaging in difficult conversations (91% response rate [126 of 139]). Parents and clinical care team members agreed that parents would likely be preferable to standardized actors for these types of role-playing exercises (84% response rate [37 of 44]). CONCLUSIONS: Involving patients' parents and an interprofessional team in role-playing scenarios was a well-received method for teaching residents how to engage in difficult conversations with patients and families, and improved their self-reported confidence when having these conversations.

The Legal Dimensions of Genomic Sequencing in Newborn Screening.

The possible integration of genomic sequencing (including whole-genome and whole-exome sequencing) into the three contexts addressed in this special report-state-mandated screening programs, clinical care, and direct-to-consumer services-raises related but distinct legal issues. This essay will outline the legal issues surrounding the integration of genomic sequencing into state newborn screening programs, parental rights to refuse and access sequencing for their newborns in clinical and direct-to-consumer care, and privacy-related legal issues attending the use of sequencing in newborns.