Perceived Success After Participation in the Summer Health Professions Education Program.

Importance: The number of active health care professionals has not kept pace with the increasing number of minoritized individuals in the US. The Summer Health Professions Education Program (SHPEP) was developed to alleviate this underrepresentation in the health workforce. Objective: To evaluate students' changes in perceived barriers and motivators for entering and succeeding in professional school after SHPEP participation. Design, Setting, and Participants: For this cohort study, anonymous electronic surveys were sent to the 2017 to 2021 SHPEP participants at an academic health center at a large university in the southern US. Participants were first- and second-year undergraduates interested in the health professions and enrolled in the SHPEP. Program participants were invited to complete the study. Exposures: An anonymous electronic survey was administered before and immediately after program completion. Main Outcomes and Measures: The SHPEP Career Barriers Survey (SCBS) is composed of 22 questions on motivators and 20 questions on barriers to entering and succeeding in health professional school. Students responded using a 5-point Likert scale, with 1 indicating strongly disagree and 5 indicating strongly agree. Mixed analysis of variance was used to analyze the program's latent factors. Results: Of all 402 SHPEP participants (mean [SD] age, 19.32 [0.88] years) from 2017 to 2021, 325 completed the preprogram survey and 259 also completed the postprogram survey. Of the 325 initial participants, 4 identified as American Indian or Alaska Native, Native Hawaiian, or Pacific Islander (1.2%); 12 as Asian (3.7%); 188 as Black (57.8%); 95 as Hispanic or Latino (29.2%); 7 as White (2.2%); and 16 as multiracial (4.9%). Two hundred twelve participants were female (65.2%), and 226 were first-generation college students (69.5%). Results of the SCBS indicate that the SHPEP had a significant small to moderate association on perceived motivators (mean [SD] x̅ = 84.60 [9.67] vs 80.95 [8.93]; P = .001) and decreases in perceived barriers (mean [SD] x̅ = 48.02 [13.20] vs 51.72 [11.39]; P = .008). There was no significant difference in program success between studied years. Conclusions and Relevance: In this cohort study, the SHPEP appeared to provide essential support for underrepresented students as measured by improved perceived motivators and reduced perceived barriers to entering professional education. Knowledge from this study can assist educators and health care professionals who wish to implement similar enrichment programs.

Interprofessional Education: An Innovative Approach to Increase the Human Immunodeficiency Virus Workforce.

Ending the human immunodeficiency virus (HIV) epidemic relies on a robust clinical workforce. The Southeast AIDS Education and Training Center's interprofessional education program is a novel approach to increasing the interest and ability of early health professional learners to provide high-quality, comprehensive, person-first care for people with HIV. Key Points: Interprofessional education (IPE) focusing on multidisciplinary care for people with HIV can serve as a novel way to increase the HIV workforce. This brief report describes the IPE program of the Southeast AIDS Education and Training Center.

Dendritic atoh1a+ cells serve as transient intermediates during zebrafish Merkel cell development and regeneration.

Sensory cells often adopt specific morphologies that aid in the detection of external stimuli. Merkel cells encode gentle touch stimuli in vertebrate skin and adopt a reproducible shape characterized by spiky, actin-rich microvilli that emanate from the cell surface. The mechanism by which Merkel cells acquire this stereotyped morphology from basal keratinocyte progenitors is unknown. Here, we establish that dendritic Merkel cells (dMCs) express atonal homolog 1a (atoh1a), extend dynamic filopodial processes, and arise in transient waves during zebrafish skin development and regeneration. We find that dMCs share molecular similarities with both basal keratinocytes and Merkel cells, yet display mesenchymal-like behaviors, including local cell motility and proliferation within the epidermis. Furthermore, dMCs can directly adopt the mature, microvilliated Merkel cell morphology through substantial remodeling of the actin cytoskeleton. Loss of Ectodysplasin A signaling alters the morphology of dMCs and Merkel cells within specific skin regions. Our results show that dMCs represent an intermediate state in the Merkel cell maturation program and identify Ectodysplasin A signaling as a key regulator of Merkel cell morphology.

A Multisite Survey of Pediatric Hospitalists' Practices in Soliciting Feedback From Trainees.

OBJECTIVE: There is evidence that pediatric attending physicians value receiving feedback from trainees. With this study, we sought to determine the extent to which pediatric hospitalists value, solicit, and receive feedback from residents and medical students on specific areas of the attending's performance and identify perceived barriers to trainees' providing feedback. METHODS: A web-based survey was sent to pediatric hospitalists at 9 institutions in 2022. Survey questions were developed from existing literature, trainee input, faculty expertise, and a framework on the qualities of exemplary pediatric educators. Respondents answered yes-no and multiitem Likert scale questions and selected answers from predetermined lists related to feedback solicitation from trainees. χ-Square and Wilcoxon rank test statistics were used to analyze questions. RESULTS: Responses were gathered from 91 of 189 surveyed individuals (response rate: 48.1%). Respondents almost unanimously "agreed" or "strongly agreed" that feedback from medical students (88, 96.7%) and residents (89, 97.8%) can be valuable, but feedback was considered more valuable from residents (P <.05). Attending physicians asked for and received feedback more from residents than from medical students (P <.05). Attending physicians most commonly asked for feedback on "teaching skills." The largest perceived barriers to receiving feedback from trainees were trainee lacking comfort with giving feedback, trainee lacking awareness that providing feedback is within their role, and fear of retaliation. CONCLUSIONS: Although pediatric hospitalist respondents nearly unanimously valued feedback from trainees, attending physicians were inconsistent in their feedback solicitation practices. Attending physicians were more likely to ask for and receive feedback from residents than from medical students.

Adding Safety Rules to Surgeon-Authored Virtual Reality Training.

INTRODUCTION: The Toolkit for Illustration of Procedures in Surgery (TIPS) is an open source virtual reality (VR) laparoscopic simulation-based training environment with force feedback. The TIPS-author is a content creation interface that allows a surgeon educator (SE) to assemble new laparoscopic training modules. New technology enables safety rules to be specified by the SE, automatically tracks specified safety errors, and summarizes and communicates achievements and errors to the surgical trainee. METHODS: The TIPS-author combines and initializes building blocks of anatomy with their physical properties, as selected by the SE from a database. The SE can add any safety rule that can be tested in terms of location, proximity, separation, clip count, and force. Errors are then automatically monitored during simulation and recorded as visual snapshots for feedback to the trainee. The TIPS was field tested at 2 surgical conferences, one before and one after adding the error snapshot feature. RESULTS: Sixty-four respondents at 2 surgical conferences assessed the utility of TIPS on a Likert scale. While other ratings remained unchanged for an overall score of 5.24 of 7 (7 = very useful), the rating of the statement "The TIPS interface helps learners understand the force necessary to explore the anatomy" improved from 5.04 to 5.35 of 7 after the snapshot mechanism was added. CONCLUSIONS: The ratings indicate the viability of the TIPS open source SE-authored surgical training units with safety rules. Presenting SE-determined procedural missteps via the snapshot mechanism at the end of the training increases perceived utility.

Zebrafish cutaneous injury models reveal that Langerhans cells engulf axonal debris in adult epidermis.

Somatosensory neurons extend enormous peripheral axons to the skin, where they detect diverse environmental stimuli. Somatosensory peripheral axons are easily damaged due to their small caliber and superficial location. Axonal damage results in Wallerian degeneration, creating vast quantities of cellular debris that phagocytes must remove to maintain organ homeostasis. The cellular mechanisms that ensure efficient clearance of axon debris from stratified adult skin are unknown. Here, we established zebrafish scales as a tractable model to study axon degeneration in the adult epidermis. Using this system, we demonstrated that skin-resident immune cells known as Langerhans cells engulf the majority of axon debris. In contrast to immature skin, adult keratinocytes did not significantly contribute to debris removal, even in animals lacking Langerhans cells. Our study establishes a powerful new model for studying Wallerian degeneration and identifies a new function for Langerhans cells in maintenance of adult skin homeostasis following injury. These findings have important implications for pathologies that trigger somatosensory axon degeneration.

Assessment of parental decision making in congenital heart disease, cardiomyopathy and heart transplantation: an observational study analysing decisional characteristics and preferences.

OBJECTIVE: We explore shared decision making (DM) in guardians of children with heart disease by assessing the desired weight of influence on DM and factors that may alter the relative weight of parent or medical team influence. METHODS: Guardians of patients <21 years and admitted >1 week in the paediatric cardiac intensive care unit (PCICU) were recruited. Twelve vignettes were designed including technical (antibiotic selection, intubation, peripherally inserted central catheter placement, ventricular assist device placement, heart transplant, organ rejection, heart rhythm abnormalities and resuscitation effort) and non-technical vignettes (cessation of life-sustaining therapies, depression treatment, obesity and palliative care referral). Participants responded to questions on DM characteristics and one question querying preference for relative weight of parent or medical team influence on DM. RESULTS: Of 209 participants approached, 183 were included. Most responded with equal desire of medical team and parental influence on DM in all vignettes (range 41.0%-66.7%). Technical scenarios formed one cluster based on DM characteristics, compared with non-technical scenarios. Factors that increase the relative weight of parental influence on DM include desired input and involvement in big-picture goals (OR 0.274, CI [0.217 to 0.346]; OR 0.794, CI [0.640 to 0.986]). Factors that increase the relative weight of medical team influence on DM include perception of medical expertise needed (OR 1.949 [1.630 to 2.330]), urgency (OR 1.373 [1.138 to 1.658]), benefit (OR 1.415 [1.172 to 1.710]), number of PCICU admissions (OR 1.134 [1.024 to 1.256]) and private insurance (OR 1.921 [1.144 to 3.226]). CONCLUSION: Although factors may alter the weight of influence on DM, most parents desire equal parental and medical team influence on DM.

Dermal appendage-dependent patterning of zebrafish atoh1a+ Merkel cells.

Touch system function requires precise interactions between specialized skin cells and somatosensory axons, as exemplified by the vertebrate mechanosensory Merkel cell-neurite complex. Development and patterning of Merkel cells and associated neurites during skin organogenesis remain poorly understood, partly due to the in utero development of mammalian embryos. Here, we discover Merkel cells in the zebrafish epidermis and identify Atonal homolog 1a (Atoh1a) as a marker of zebrafish Merkel cells. We show that zebrafish Merkel cells derive from basal keratinocytes, express neurosecretory and mechanosensory machinery, extend actin-rich microvilli, and complex with somatosensory axons, all hallmarks of mammalian Merkel cells. Merkel cells populate all major adult skin compartments, with region-specific densities and distribution patterns. In vivo photoconversion reveals that Merkel cells undergo steady loss and replenishment during skin homeostasis. Merkel cells develop concomitant with dermal appendages along the trunk and loss of Ectodysplasin signaling, which prevents dermal appendage formation, reduces Merkel cell density by affecting cell differentiation. By contrast, altering dermal appendage morphology changes the distribution, but not density, of Merkel cells. Overall, our studies provide insights into touch system maturation during skin organogenesis and establish zebrafish as an experimentally accessible in vivo model for the study of Merkel cell biology.

Dental student perceptions of teamwork during a community-engaged interprofessional learning experience.

INTRODUCTION: Dental professionals have been strong advocates for interprofessional education (IPE). During PFF, students in diverse, interprofessional teams of four are assigned a local volunteer family during their first academic year. Teams conduct four home visits and implement a health improvement project focused on the family's health and well-being. The purpose of our analysis was to examine dental student perspectives on the use of teamwork skills during this unique interprofessional educational experience. METHODS AND MATERIALS: Dental student responses from 2017 to 2018 and 2018 to2019 were qualitatively analysed. Open coding by hand was used to identify keywords and themes. The themes and open codes were compared and contrasted by the researchers until a consensus was reached on themes. RESULTS: Researchers discerned three meta-themes: value, skills and time. Researchers also found eight sub-themes prevalent in responses: teamwork, adaptability, mutual support, trust, interprofessional communication, time, feedback, coordination and accountability. DISCUSSION: Our findings indicate dental students understood the importance of interprofessional teamwork and experiential learning within the context of PFF. Students communicated an understanding of how teamwork skills can impact team-oriented outcomes. Dental students seemed to value many teamwork skills that contributed to their interprofessional team's success and experiential learning experience. CONCLUSION: Engagement in a longitudinal experience that is patient-centred, requiring time outside of the classroom, is valued by dental students for its interprofessional collaborative competency development.

Script Concordance Tests for Formative Clinical Reasoning and Problem-Solving Assessment in General Pediatrics.

Introduction: Script Concordance Tests (SCTs) are short clinical vignettes with proposed diagnoses, diagnostic studies, treatments, and management options for patient care scenarios. The SCTs included in this resource were incorporated into a required pediatric clerkship to facilitate formative student feedback and additional opportunities for precepting faculty to provide midclerkship feedback. Pediatric cases were specifically selected due to the scarcity of medical student experience with common pediatric clinical presentations. Methods: We developed eight themed SCTs comprising 72 individual test items focused on common topics in general pediatrics. Items were administered to a convenience sample of third-year medical students during their required pediatric clerkship between fall 2016 and spring 2020. To evaluate the SCTs, we conducted item analyses, as well as comparing student performance to summative assessments. Results: The mean aggregate percentage score across all SCTs was .84 (SD = .08). Student SCT performance was related to USMLE Step 2 Clinical Knowledge scores, clerkship grades, and NBME Pediatrics Shelf Exam scores. Discussion: These SCTs facilitated feedback to medical students in the clinical learning environment. Their current form provides a means of exploring student clinical reasoning and problem-solving and can be used at a single point or to measure longitudinally. When paired with structured subject- and competency-specific midclerkship student evaluation, SCTs helped facilitate timely feedback to students via immediate explanations of each question. SCTs can assist students in recognizing and reflecting on potential knowledge gaps.

Exploring paediatricians' experiences with performance improvement modules and quality improvement.

OBJECTIVE: The American Board of Pediatrics' (ABP) maintenance of certification (MOC) programme seeks to continue educating paediatricians throughout their careers by encouraging lifelong learning and continued improvement. The programme includes four parts, each centring on a different aspect of medical practice. Part 4 MOC centres on quality improvement (QI). Surveys by the ABP suggest that paediatricians are dissatisfied with aspects of part 4, but their reasons are unclear. This study sought to explore factors contributing to dissatisfaction with part 4 by focusing on performance improvement modules (PIMs), a popular means of achieving part 4 credit. METHODS: The study used cross-sectional purposive sampling drawing from US physicians working in a range of practice settings: private outpatient, hospital, academic and low-income clinics. The sampling frame was divided by practice characteristics and satisfaction level, derived from a five-point Likert item asking about physician satisfaction regarding a recent PIM. In-depth interviews were conducted with 21 physicians, and the interview data were coded, categorised into themes and analysed using a framework analysis approach. RESULTS: Paediatricians expressed nuanced views of PIMs and remain globally dissatisfied with part 4, although reasons for dissatisfaction varied. Concerns with PIMs included: (1) excessive time and effort; (2) limited improvement and (3) lack of clinically relevant topics. While most agreed that QI is important, participants felt persistently dissatisfied with the mechanics of doing PIMs, especially when QI tasks fell outside of their typical work regimen. CONCLUSIONS: Paediatricians agreed that part 4, PIMs, and QI efforts in general still lack clinical relevance and need to be more easily incorporated into practice workflow. Clinicians specifically felt that PIMs must be directly integrated with physicians' practice settings in terms of topic, data quality and metrics, and must address practice differences in time and monetary resources for completing large or complex projects.

Hospital homebound students and K-12 online schooling.

The flexibility afforded by online education may provide opportunities for learners with disability who require absence from traditional learning environments. This study sought to describe how a subset of learners with disability, those with hospital-homebound designation, perform in K-12 online classes, particularly as compared to non-hospital homebound counterparts. A cross-sectional analysis was performed of all Florida Virtual School course enrollments from August 1, 2012 to July 31, 2018. Researchers analyzed 2,534 course enrollments associated with K-12 students who, at the time of their course enrollment, had hospital-homebound designation, and a comparison group of 5,470,591 enrollments from K-12 students without hospital-homebound status. Data analysis showed three important outcomes. First, hospital-homebound designated student academic performance was equivalent to their non-hospital homebound counterparts. Second, however, hospital-homebound course enrollments were 26% more likely to result in a withdrawal prior to grade generation. Third, these withdrawals were potentially mitigated when H/H designated students were enrolled in five or more classes or in classes with five or more students. The results of this study provided evidence that when they can remain enrolled, hospital-homebound learners experience equivalent academic outcomes in online learning environments. These findings suggest that healthcare professionals should be made aware of the potentially equivalent outcomes for their patients. Moreover, virtual schools should seek to identify and create supports for these students.

Goodness of Fit of the Clinical Instructor Teaching Effectiveness Survey (CITES) for Health Professions Students.

Student evaluations of teaching have demonstrated limited validity in traditional classrooms, but there is some evidence that they may be more useful in measuring teaching effectiveness in simulation or clinical environments. Current student evaluations of clinical teaching measure a subset of constructs designed for use by a single profession, which may limit institutional evaluation and make interprofessional evaluations challenging. The purpose of this study was to describe the multi-step creation of the CITES and to establish its internal consistency and goodness of fit for measuring students' perceptions of clinical instructor teaching effectiveness. In its second iteration, the CITES is a 25-item questionnaire that was tested among 161 physical therapy and physician assistant students. Most items, with the exception of item 5, demonstrated goodness of fit, with a standardized coefficient of 0.94. Internal consistency was high, with a Cronbach alpha of 0.96-0.97. Though this tool demonstrates internal consistency and goodness of fit, the test information curve indicated that it would be more useful as a screening tool to detect those who are very poor clinical teachers, rather than a tool to evaluate those who are highly effective at teaching.

Design of a Situational Judgment Test for Preclinical Interprofessional Collaboration.

PROBLEM: There is an unmet need for economically feasible, valid, reliable, and contextually relevant assessments of interprofessional collaborative knowledge and skills, particularly at the early stages of health professions education. This study sought to develop and gather content and internal structure validity for an Interprofessional Situational Judgement Test (IPSJT), a tool for the measurement of students' interprofessional collaborative intentions during the early stages of their professional development. APPROACH: After engaging in an item development and refinement process (January-June 2018), an 18-question IPSJT was administered to 953 first-year students enrolled in 10 health professions degree programs at the University of Florida Health Science Center in October 2018. The IPSJT's performance was evaluated using item-level analyses, item difficulty, test-retest reliability, and exploratory factor analysis. OUTCOMES: Seven hundred thirty-seven (77.3%) students consented to the use of their data. Student IPSJT scores ranged from 0 to 69, averaging 42.68 (standard deviation = 12.28), with some statistically significant differences in student performance by health professions degree program. IPSJT item difficulties ranged from 0.13 to 0.92. Once one item with poor properties was excluded from analysis, the IPSJT demonstrated an overall reliability of 0.62. Students were more successful at identifying the least effective than the most effective responses. Test-retest reliability provided evidence of consistency (r = 0.50, P < .001) and similar item difficulty across administrations. An exploratory factor analysis indicated a 3-factor model with multiple cross-factor loadings. NEXT STEPS: This work represents the first step toward the development of a valid, reliable IPSJT for early learners. The emergent 3-factor model provides evidence that multiple competencies can be assessed in early learners via this tool. Additional research is necessary to build a more robust question bank, explore different scoring and response methods, and gather additional sources of validity evidence, including relations to other variables.

Glia actively sculpt sensory neurons by controlled phagocytosis to tune animal behavior.

Glia in the central nervous system engulf neuron fragments to remodel synapses and recycle photoreceptor outer segments. Whether glia passively clear shed neuronal debris or actively prune neuron fragments is unknown. How pruning of single-neuron endings impacts animal behavior is also unclear. Here, we report our discovery of glia-directed neuron pruning in Caenorhabditis elegans. Adult C. elegans AMsh glia engulf sensory endings of the AFD thermosensory neuron by repurposing components of the conserved apoptotic corpse phagocytosis machinery. The phosphatidylserine (PS) flippase TAT-1/ATP8A functions with glial PS-receptor PSR-1/PSR and PAT-2/α-integrin to initiate engulfment. This activates glial CED-10/Rac1 GTPase through the ternary GEF complex of CED-2/CrkII, CED-5/DOCK180, CED-12/ELMO. Execution of phagocytosis uses the actin-remodeler WSP-1/nWASp. This process dynamically tracks AFD activity and is regulated by temperature, the AFD sensory input. Importantly, glial CED-10 levels regulate engulfment rates downstream of neuron activity, and engulfment-defective mutants exhibit altered AFD-ending shape and thermosensory behavior. Our findings reveal a molecular pathway underlying glia-dependent engulfment in a peripheral sense-organ and demonstrate that glia actively engulf neuron fragments, with profound consequences on neuron shape and animal sensory behavior.

Neurons are tree-shaped cells that receive information through endings connected to neighbouring cells or the environment. Controlling the size, number and location of these endings is necessary to ensure that circuits of neurons get precisely the right amount of input from their surroundings. Glial cells form a large portion of the nervous system, and they are tasked with supporting, cleaning and protecting neurons. In humans, part of their duties is to 'eat' (or prune) unnecessary neuron endings. In fact, this role is so important that defects in glial pruning are associated with conditions such as Alzheimer's disease. Yet it is still unknown how pruning takes place, and in particular whether it is the neuron or the glial cell that initiates the process. To investigate this question, Raiders et al. enlisted the common laboratory animal Caenorhabditis elegans, a tiny worm with a simple nervous system where each neuron has been meticulously mapped out. First, the experiments showed that glial cells in C. elegans actually prune the endings of sensory neurons. Focusing on a single glia-neuron pair then revealed that the glial cell could trim the endings of a living neuron by redeploying the same molecular machinery it uses to clear dead cell debris. Compared to this debris-clearing activity, however, the glial cell takes a more nuanced approach to pruning: specifically, it can adjust the amount of trimming based on the activity load of the neuron. When Raiders et al. disrupted the glial pruning for a single temperature-sensing neuron, the worm lost its normal temperature preferences; this demonstrated how the pruning activity of a single glial cell can be linked to behavior. Taken together the experiments showcase how C. elegans can be used to study glial pruning. Further work using this model could help to understand how disease emerges when glial cells cannot perform their role, and to spot the genetic factors that put certain individuals at increased risk for neurological and sensory disorders.

Using Data Mining for the Early Identification of Struggling Learners in Physician Assistant Education.

PURPOSE: Despite the importance of early intervention and remediation, the relatively short duration of physician assistant education programs necessitates the importance of early identification of at-risk learners. This study sought to ascertain whether machine learning was more effective than logistic regression in predicting remediation status among students, using the limited set of data available before or immediately following the first semester of study as predictor variables and academic remediation as an outcome variable. METHODS: The analysis included one institution and student data from 177 graduates between 2017 and 2019. We employed one data mining model, random forest trees, and compared it to a traditional predictive analysis method, logistic regression. Due to the small sample size, we employed leave-one-out cross-validation and bootstrap aggregation. RESULTS: Data provided evidence that the random forest algorithm correctly identified individuals who would later experience academic intervention with a 63.3% positive predictive value, whereas logistic regression exhibited a positive predictive value of 16.6%. CONCLUSIONS: This single-institution study indicates that predictive modeling, employing machine learning, may be a more effective means than traditional statistical methods of identifying and providing assistance to learners who may experience academic challenges.

Using machine learning analysis to assist in differentiating between necrotizing enterocolitis and spontaneous intestinal perforation: A novel predictive analytic tool.

PURPOSE: Necrotizing enterocolitis (NEC) and spontaneous intestinal perforation (SIP) are devastating diseases in preterm neonates, often requiring surgical treatment. Previous studies evaluated outcomes in peritoneal drain placement versus laparotomy, but the accuracy of the presumptive diagnosis remains unknown without bowel visualization. Predictive analytics provide the opportunity to determine the etiology of perforation and guide surgical decision making. The purpose of this investigation was to build and evaluate machine learning models to differentiate NEC and SIP. METHODS: Neonates who underwent drain placement or laparotomy NEC or SIP were identified and grouped definitively via bowel visualization. Patient characteristics were analyzed using machine learning methodologies, which were optimized through areas under the receiver operating characteristic curve (AUROC). The model was further evaluated using a validation cohort. RESULTS: 40 patients were identified. A random forest model achieved 98% AUROC while a ridge logistic regression model reached 92% AUROC in differentiating diseases. When applying the trained random forest model to the validation cohort, outcomes were correctly predicted. CONCLUSIONS: This study supports the feasibility of using a novel machine learning model to differentiate between NEC and SIP prior to any intended surgical interventions. LEVEL OF EVIDENCE: level II TYPE OF STUDY: Clinical Research Paper.