An Interactive, Case-Based Workshop on the Patient Experience for Internal Medicine Residents.

Introduction: The technological revolution has narrowed the information gap between physician and patient. This has led to an evolution in medicine from paternalistic to patient-centric, with health care systems now prioritizing patient experience to achieve higher satisfaction scores. Therefore, it is imperative to start early in educating trainees on how to best address the holistic needs of the patient while also delivering high-quality care. Methods: We implemented a 1-hour workshop that was repeated weekly over 8 weeks to capture all internal medicine residents in our program. During the workshop, we reviewed the historical evolution of patient care from paternalistic to patient-centered, presented the Hospital Consumer Assessment of Healthcare Providers and Systems survey questions, and discussed evidence-based strategies for physicians to improve their patients' experience utilizing four case-based scenarios. Results: Over the 8-week period, a total of 195 residents participated in the workshop. One hundred thirty-nine residents (71%) completed the pre- and postsession survey. Results demonstrated significant knowledge improvement (p < .001) in all of the topics discussed. Additionally, the majority of residents felt the workshop would be useful in their clinical practice and found the clinical scenarios useful. Discussion: Given the evolution towards patient-centered care, it is important to take a proactive approach in providing residents with the tools to best address their patients' needs. Early understanding of patient satisfaction surveys and the impacts they have on hospital metrics can help trainees in their careers as practicing physicians.

Evaluating the effect of cochlear implantation age on pragmatic abilities before and after age of 3.

INTRODUCTION: The cochlear implant (CI) is crucial in developing hearing, speech, language, and communication skills in children with profound hearing loss (HL). The study aimed to assess how the age at which children receive a CI affects the development of pragmatic abilities between the ages of 5 and 8 for those who received a CI before or after the age of 3. METHODS: Forty children with CI were evaluated. The children between the ages of 5 and 8 were divided into two groups who received CIs before or after age 3. The Persian version of the Children's Communication Checklist (CCC) was used to assess pragmatic abilities with a parent rating scale. RESULTS: Children implanted under 3 got higher scores in social relationships, using context, conversational rapport, syntax, and speech. Also, their performance in inappropriate and stereotyped conversations was better than those over 3 years. They have a significant difference in the pragmatic composite than those who received CI over 3 except for coherence and interest (p < 0.05). CONCLUSION: According to the results, children with CI under 3 performed better in pragmatic composites, which means they have better pragmatic abilities. These findings suggest that early CI is important. Of course, other individual and environmental factors must also be considered.

An Authentic Learning Experience for Medical Students on Conducting a Family Meeting.

BACKGROUND: Medical schools often lack training for serious illness conversations with patients and caregivers. We developed a curriculum in our elective Transitioning to Residency medical student course, focused on end-of-life discussions. This paper provides an overview of the curriculum and outcomes from an advanced preparation assignment and student evaluations. METHODS: The curriculum included a "hands-on" skills session delivered via Zoom. Small groups of students (3-4) assumed roles on an interprofessional team (Intensivist, cardiologist, nurse, social worker). They met with two adult children, played by palliative/geriatric clinical staff, of a 79-year-old patient with a complex cardiac history and on ventilator support to address: (1) the patient's status, (2) goals of care, and (3) withdrawal of ventilator support. Using a flipped classroom format, students reviewed the case, role assignments, a family meeting webinar, and other materials in advance. They completed a survey reflecting on the upcoming family meeting. Afterwards, students evaluated the session. RESULTS: Eighty students (19.6%) participated in 2021 and 2022. The reflection survey shows students agreed the patient's prognosis was poor and decision-making should be shared. They anticipated difficulty accepting prognosis, discordance between family members and/or the team, and challenging emotions. Results show a difference between the anticipated roles of the assigned physicians compared to the other disciplines. Post-session evaluations ranged from 4.7 to 4.9/5 (1 = strongly disagree, 5 = strongly agree). CONCLUSION: The pre-session reflection helped students prepare for their roles. The training was well received, and we hope it prepares students to take on serious illness discussions during residency.

Responding to Interprofessional Microaggressions: Bystander Training-A Virtual Simulation Curriculum for Internal Medicine Residents.

Introduction: Literature demonstrates the detrimental impact of discrimination and microaggressions at personal and institutional levels in the health care workplace. Residents in our program requested curricula to help with addressing manifestations of bias. In response, we designed and implemented an adaptable and reproducible 4-hour virtual simulation session aimed at helping residents identify and constructively respond to microaggressions. Methods: This curriculum, influenced by a preceding needs assessment, was delivered to 68 senior internal medicine residents. It began with a didactic overview to establish foundational knowledge of bias. This was followed by a workshop focused on strategies to address microaggressions. The session culminated with skills practice in a virtual simulation activity where learners addressed microaggressions as bystanders in realistic case scenarios employing simulated participants. We administered pre- and postevaluation individual key-linked surveys assessing learner confidence in responding to microaggressions. Results: A total of 68 residents participated in the curriculum over two academic years, 27 of whom provided complete data for analysis. Overall, there was a statistically significant increase in learner confidence identifying microaggressions. As both a bystander and target/recipient of microaggressions, there were statistically significant increases in learner confidence addressing gender-based microaggressions, race-based microaggressions, and microaggressions reflecting other types of bias. Furthermore, there were statistically significant increases in learner confidence addressing microaggressions in low-acuity contexts, high-acuity contexts, across interprofessional disciplines, with a supervisor, and with a supervisee. Discussion: Our virtual experiential curriculum on responding to microaggressions can help increase learner confidence in addressing microaggressions.

A Simulation to Improve Understanding and Communication of Ethical Dilemmas That Surround Brain Death.

Introduction: Providers across multiple specialties may be called upon to perform brain death assessments at hospitals that lack specialty neurology or critical care services. To address this need, we developed a brain death curriculum involving simulation and group discussion to prepare medical trainees for brain death testing and communication with surrogate decision-makers. Methods: A 1-hour session was delivered to trainees rotating through the intensive care unit at William Beaumont University Hospital. One trainee per session participated in a simulation involving a brain-dead patient (SimMan 3G Mannequin) and spouse (confederate) while the remainder of the cohort observed from a separate room. The trainee briefed the spouse about the brain death examination, performed the examination, and communicated their findings. Afterward, the cohort discussed the history, law, and common ethical and communication issues that surround brain death. Results: A total of 35 trainees participated from August 2022 to March 2023. After the session, trainees were more comfortable performing brain death testing (p < .001), responding to ethical issues (p < .001), and communicating with families (p < .001). However, the session did not change their frustration with family members who have a circulatory (p = .72) or high brain (p = .52) view of death. Discussion: The simulation had a positive impact on medical trainees' ability to perform brain death testing and their comfort level in discussing complex ethical issues that surround brain death. Our results support continued simulation training for medical trainees to better prepare them for clinical practice.

Speaking accuracy and fluency among EFL learners: The role of creative thinking, emotional intelligence, and academic enthusiasm.

This study examines the associations between speaking accuracy and fluency among English as a Foreign Language (EFL) learners and emotional intelligence (EI), creative thinking (CT), and academic enthusiasm (AE). Quantitative data was used in a thorough analysis that was carried out utilizing a cross-sectional design. Three hundred and twenty EFL learners were chosen as a sample using a multi-stage cluster sampling technique. The creativity questionnaire by Abedi, the EI questionnaire by Schutte et al. and the AE questionnaire by Fredricks et al. were all completed by the participants. Quantitative data analysis was conducted using SPSS 25.0 and AMOS 24.0. The results showed a strong positive association between better speaking accuracy and fluency and greater levels of CT, EI, and AE. More precisely, learners with greater EI were able to control their emotions better, which improved their ability to speak clearly and fluently. Speaking performance was improved by those with higher CT because they showed improved problem-solving abilities and linguistic originality. High AE was also associated with better language practice and competence due to higher desire and involvement. These findings imply that encouraging CT, EI, and AE in language learning settings can greatly improve learners' speaking ability. To better understand the impact of other elements on speaking proficiency, future research should look into motivation, self-esteem, and learning methodologies.

Acknowledging and Addressing Microaggressions: A Virtual Experiential Learning Approach for Faculty.

Introduction: Although the ACGME and other accrediting organizations are increasingly emphasizing the importance of clinical learning environments that value diversity, equity, and inclusion, faculty development surrounding behavioral skills that promote inclusivity in the learning environment still needs cultivation. We designed a virtual longitudinal faculty development curriculum focused on direct observation, feedback, and practice of behavioral skills to acknowledge and address microaggressions in the learning environment. Methods: We used Kern's six steps of curriculum development to create four voluntary virtual workshops offered twice throughout the academic year, with topics including: (1) recognizing and naming microaggressions, (2) apologizing when harm has been experienced, (3) setting expectations surrounding microaggressions, and (4) debriefing microaggressions. Participant learners included residency program directors, associate program directors, and other leaders across all medical and surgical departments from one institution. Results: Thirty-one faculty from 10 departments participated in this yearlong curriculum. Pre- and postworkshop surveys analyzed participants' self-assessments of confidence and comfort in applying learned skills. Participants were more confident in openly naming bias, delivering expectations surrounding microaggressions, and debriefing microaggressions with learners. Participants also reported greater comfort in apologizing to learners when harm has occurred in public, in person, and electronically. Discussion: To create an inclusive learning environment, faculty can increase their comfort and confidence with addressing bias and microaggressions through practice and feedback. Our curriculum demonstrates how experiential learning allows for continual practice to solidify a new skill.

Mitigating Misinformation Toolkit: Addressing COVID-19 Misinformation Through Interprofessional Learning and Collaboration Using a Standardized Patient-Based Educational Module.

Introduction: Medical mis- and disinformation are on the rise and impact patient health outcomes. The complexity of modern medicine and health care delivery necessitates that care be delivered by an interprofessional team of providers well versed in addressing this increased prevalence of medical misinformation. Health professions educational curricula often lack opportunities for students to learn how to address medical misinformation, employ advanced communication techniques, and work collaboratively. Methods: Based on literature and our previous qualitative research, we created a module offering prework learning on COVID-19 and addressing misinformation through advanced communication techniques and interprofessional collaboration. After completing prework, students participated in a standardized patient encounter addressing COVID misinformation. Health professions student dyads completed a preencounter planning huddle and together interviewed a standardized patient. Students received global and checklist-based feedback from standardized patients and completed pre- and postsession self-assessments. Results: Twenty students participated (10 third-year medical, nine third-year pharmacy, one fourth-year pharmacy). Key findings included the following: Nine of 15 survey questions demonstrated statistically significant improvement, including all three questions assessing readiness to have difficult conversations and six of 10 questions assessing interprofessional collaboration and team function. Discussion: Students participating in this novel curriculum advanced their readiness to address medical misinformation, including COVID-19 vaccine disinformation, with patients and coworkers to improve health decision-making and patient care. These curricular methods can be customized for use with a range of health professions learners.

Preparing nursing students to communicate with mental health patients: A scoping review.

AIM/OBJECTIVE: This review aims to examine and synthesize the existing literature on various teaching strategies for preparing nursing students to initiate conversations with patients with mental health concerns. BACKGROUND: The increase in adults experiencing mental illnesses each year in the United States emphasizes the need for proficient communication between healthcare workers and patients with mental health concerns. Nursing students have reported feeling anxious and uncomfortable initiating difficult conversations with patients who have mental illnesses or concerns thus, effective teaching strategies are essential to enhance their communication skills, confidence, and interactions. This scoping review aims to identify and evaluate educational interventions that can better prepare nursing students for these critical conversations. DESIGN: This scoping review follows PRISMA guidelines and the JBI Manual for Evidence Synthesis. METHOD: Scopus, Academic Search Elite, and CINAHL identified 96 potentially relevant articles published between 2013 and 2023. A total of 11 articles met the criteria for inclusion in this review. RESULTS: Three themes were identified: (1) peer learning, (2) blended learning, and (3) simulation learning. The findings of these articles indicate that simulation is the most widely used teaching strategy for preparing nursing students for mental health nursing. CONCLUSION: This review revealed important insight into how implementing various teaching strategies can affect nursing students' knowledge, skills, and attitudes when communicating with a patient with mental health concerns. Gaps in literature were identified for future research.

Pre-post assessment of student application of medication therapy management skills in virtual environments using English and non-English patients.

BACKGROUND AND PURPOSE: A Medication Therapy Management (MTM) encounter allows pharmacists to gather information to make appropriate assessments and recommendations regardless of the patient's language needs and the encounter environment utilized. With the goal of improving comfort and confidence in providing MTM services, working with an interpreter, and providing care in a virtual environment, students participated in a virtual MTM activity with English and non-English speaking patients. EDUCATIONAL ACTIVITY AND SETTING: In groups, students completed two MTM encounters during a virtual skills laboratory. Students were asked to complete a pre- and post-lab survey to gauge their confidence before and after completing these encounters. One encounter was with an English-speaking patient, and one was with a non-English speaking patient which utilized an interpreter for communication. Both encounters were completed using a virtual platform. FINDINGS: As a result of these activities, students reported improved confidence in providing MTM services to a patient who speaks a language different than themselves and managing patients using a virtual platform. Students self-identified that teamwork and pre-encounter preparation were essential for effective MTM services. SUMMARY: Students found completing virtual MTM was a beneficial way to improve comfort and confidence with navigating virtual platforms, gathering medication information, and working with interpreters.

Can written prompts help medical residents to accurately monitor their own communication skills and those of others?

In healthcare, effective communication in complex situations such as end of life conversations is critical for delivering high quality care. Whether residents learn from communication training with actors depends on whether they are able to select appropriate information or 'predictive cues' from that learning situation that accurately reflect their or their peers' performance and whether they use those cues for ensuing judgement. This study aimed to explore whether prompts can help medical residents improving use of predictive cues and judgement of communication skills. First and third year Kenyan residents (N = 41) from 8 different specialties were randomly assigned to one of two experimental groups during a mock OSCE assessing advanced communication skills. Residents in the intervention arm received paper predictive cue prompts while residents in the control arm received paper regular prompts for self-judgement. In a pre- and post- test, residents' use of predictive cues and the appropriateness of peer-judgements were evaluated against a pre-rated video of another resident. The intervention improved both the use of predictive cues in self-judgement and peer-judgement. Ensuing accuracy of peer-judgements in the pre- to post-test only partly improved: no effect from the intervention was found on overall appropriateness of judgements. However, when analyzing participants' completeness of judgements over the various themes within the consultation, a reduction in inappropriate judgments scores was seen in the intervention group. In conclusion, predictive cue prompts can help learners to concentrate on relevant cues when evaluating communication skills and partly improve monitoring accuracy. Future research should focus on offering prompts more frequently to evaluate whether this increases the effect on monitoring accuracy in communication skills.

Developing effective communication skills in audiology using anonymous patient feedback.

OBJECTIVE: To explore the value of anonymous patient feedback for audiology students, examining alignment between student and patient judgments on communication skills and assessing how students utilise the feedback. DESIGN: This study utilised a mixed methods design, employing a Likert survey to collect patient and student ratings on professionalism, compassion, and listening and talking skills in clinical encounters. Semi-structured interviews investigated the student perspective of receiving patient feedback. STUDY SAMPLE: 13 Audiology students and 31 patients who were placed at, or received care at an Audiology teaching clinic. RESULTS: Patients' ratings across all measures were higher on average when compared to students' self-ratings, only correlating significantly for the measure concerning students' talking skills. Five themes and one subtheme were identified: Emotional impacts, A worthwhile experience, Contrasting priorities, Patients retake centre stage, and Self-reflective learners (subtheme Self-doubt). CONCLUSIONS: This study reveals that patient feedback led student Audiologists to report heightened seriousness in their interactions and increased attention on skills vital for patient-centred care. The process boosted students' confidence and reinforced awareness of the patient's perspective. Further research is needed to gauge the extent of these effects and explore the feasibility of implementing a large-scale patient feedback program in audiology training settings.

Mitigating Misinformation Toolkit: Online Simulation and Standardized Patient Cases for Interprofessional Students to Address Vaccine Hesitancy and Misinformation.

Introduction: Medical misinformation, which contributes to vaccine hesitancy, poses challenges to health professionals. Health professions students, while capable of addressing and advocating for vaccination, may lack the confidence to engage with vaccine-hesitant individuals influenced by medical misinformation. Methods: An interprofessional in-person simulation activity (90 minutes) using standardized patients was developed and instituted for students in medicine, nursing, pharmacy, and public health programs. Student volunteers were recruited from classes approximately halfway through their respective degree programs (i.e., second or third year of a 4-year program). Online simulation was used as a method to prepare for in-person simulation. Impact on students was assessed primarily through a postprogram student self-assessment. Results: A total of 220 students participated in the program; 206 (94%) had paired data available to analyze. Following program participation, self-assessed abilities increased from pre to post, from 2.8 out of 5 (good) to 3.9 out of 5 (very good; p < .001). Ninety-eight percent of students felt that their ability to address medical misinformation was somewhat/much better after the activity, compared to before, and that their ability to address vaccine hesitancy was somewhat/much better. The overall program was rated highly, with mean scores for each program evaluation item >4 out of 5 (very good). Discussion: An interprofessional cohort of students demonstrated improvement in self-assessed skills to participate in a conversation with an individual with hesitancy to receive vaccines and/or beliefs informed by misinformation. Students felt that this program was relevant and important to their professional development.

Empathic communication skills training to reduce lung cancer stigma: Study protocol of a cluster randomized control trial.

BACKGROUND: Prior research demonstrates that nearly all (95 %) people with lung cancer (PwLC) report stigma, and approximately half (48 %) PwLC experience stigma during clinical encounters with oncology care providers (OCPs). When stigma is experienced in a medical context, it can have undesirable consequences including patients' delaying and underreporting of symptoms, misreporting of smoking behavior, and avoiding help-seeking such as psychosocial support and cessation counseling. Multi-level interventions are needed to prevent and mitigate lung cancer stigma. One promising intervention for reducing patient perception and experience of stigma is to train OCPs in responding empathically to patient emotions and promoting empathic communication within clinical encounters. METHODS: This paper describes the study protocol for a cluster randomized trial comparing Usual Care (waitlist control group) with Empathic Communication Skills (ECS) training (intervention group). For this study, we will recruit 16 community oncology practice sites, 9-11 OCPs per site, and 6 PwLCs per OCP. RESULTS: The goal of this trial is to investigate the effect of the ECS training on (a) OCP primary outcomes (communication and empathic skill uptake) and secondary outcomes (ECS training appraisal - relevance, novelty, clarity; self-efficacy, attitude towards communication with patients); and (b) patient-reported primary outcomes (lung cancer stigma), and secondary outcomes (perceived clinician empathy, satisfaction with OCP communication, psychological distress, social isolation, and appraisal of care). CONCLUSION: Findings from this trial will advance understanding of the effectiveness of the ECS training intervention and inform future provider-level training interventions that may reduce lung cancer stigma and improve cancer care delivery. CLINICALTRIALS: govIdentifier: NCT05456841.

[The humanization of medical education: publications review].

The humanization of medical education is targeted at integration of humanitarian values and approaches into system of education of medical personnel to improve their professional and personal training. This process includes education in medical ethics, development of communication skills, stress management and implementation of humanitarian disciplines into the curriculum. The humanization contributes into formation of empathy, responsibility and professionalism in future physicians that helps to better understand and consider psychological, social and emotional needs of patients. The problems of including humanitarian sciences into medical education are associated with lack of systematic approach, adequate curricula and qualified lecturers. To optimize process, it is necessary to focus on education of ideals and beliefs, development of integrated curricula and enhancement of humanitarian component of education.

"Bring your worst": Residents' perspectives on video review of challenging patient communication as a learning tool.

Objective: To investigate residents' experiences recording and receiving feedback on a challenging video of a patient encounter. Methods: We used a qualitative design with first year residents who took part in a mandatory communication skills course in which all participants were asked to bring a challenging video of a patient encounter. The methods consisted of brief reflection texts and focus groups related to their perspectives on the use of challenging videos. Results: 106 residents wrote brief reflection texts, and 13 residents participated in four focus groups. Residents mainly expressed positive experiences with the challenging video exercise. Residents reported that the pressure to perform was felt to be less than on previous teaching sessions because the focus was on choosing an encounter which was less than perfect. They also reported that they appreciated the opportunity to see that other doctors were not performing optimally. Conclusion: The use of challenging videos as a teaching method for communication skills was experienced as encouraging by residents and facilitated enhanced learning. Innovation: We recommend adding more focus on challenging situations in video review. This could support learning by providing what our participants found to be a less daunting learning environment.

Transforming medical students' speaking-up behaviors in medical errors: The impact of simulation and personalized debriefing.

INTRODUCTION: Sharing mental models is essential for high-performance teams, and speaking up is key for exchanging critical insights, especially during medical errors. Understanding how health providers and trainees voice their concerns is crucial for improving speaking-up behavior. This study aims to fill a gap in the literature by examining how medical students speak up when they encounter medical errors and assessing the impact of training on their speaking-up patterns. METHOD: A quasi-experimental study involving 146 students, who were divided into two groups, was conducted in Northern Taiwan. One group of students encountered life-threatening scenario before intervention, followed by a faculty-led personalized debriefing session, then a non-life-threatening scenario after the intervention. Another group of students underwent these sessions in the reverse order. Students' Speaking-up patterns, including expression style, form and attitude, and their speaking-up confidence were assessed at pre- and post-intervention scenarios. RESULTS: During pre-intervention scenario, in expression style, 50 students (34.5%) addressed their concerns to medical errors with direct expression and 14 students (9.7%) utilized indirect hint to express their concerns. In expression form, 31 students (21.4%) addressed their concerns to medical errors with affirmative sentences and 33 students (22.8%) asked questions to express their concerns. In speaking-up attitude, 47 students (32.4%) used unoffensive words, while 17 students (11.7%) used offensive words. After intervention, significantly change of speaking-up styles, forms, and attitude were observed along with their speaking-up confidence (p < 0.001). DISCUSSION: Medical students are inclined to speak up in the event of medical errors using more direct expression and affirmative sentences, along with increased speaking-up confidence after simulation scenario learning and faculty-led personalized debriefing. Healthcare educators can focus more on discussing with students the advantages and disadvantages of various approaches of speaking-up in medical errors, helping them to develop effective speaking-up behaviors in a variety of medical contexts.

Bridging the gap: evaluation of preoperative patients' education by comparing expectations and real-perioperative surgical experiences: a mixed-methods descriptive cross-sectional study.

BACKGROUND: Educating patients regarding surgery is an important aspect of the preoperative process. It helps individuals answer their queries, reduce anxiety, and improve overall satisfaction with the surgical experience. OBJECTIVE: To compare patients' expectations with their real-perioperative surgical experiences. Also, to evaluate the effectiveness of preoperative education and, thus, improve the doctor-patient relationship. METHODOLOGY: Through consecutive sampling, 65 adult patients were selected from the ENT department of Khyber Teaching Hospital. Preoperative education was provided to all the subjects using a 25-point pro-forma, and their queries were addressed. Postoperatively, all participants were interviewed regarding their expectations and real perioperative surgical experiences. The gaps were noted, and participants were asked about their preferences for addressing such gaps in future interactions. Postoperatively, patients were asked to give comments on how a certain part of preoperative education could have been better delivered. RESULTS: Among the 65 patients, 28 (43.1%) were male, and 37 (56.9%) were female. The majority (38.5%) had a primary/secondary school education. Eight (12.3%) patients had ear surgery, 19 (29.2%) had nose surgery, and 38 (58.5%) had throat surgery. Almost 39 (60%) patients had preoperative fear/anxiety. After preoperative education, 17 (26.2%) patients experienced perioperative fear/anxiety, which was a significant reduction (p = 0.001). Preoperative anxiety was greater in females (M: F = 8:13, p = 0.00), while perioperative anxiety was comparable among both genders after patient education (M: F = 5:12, p = 0.18). The greatest dissatisfaction was noted regarding the surgical schedule (33.8%), range of motion (16.9%), deep breathing exercises (13.8%), and preoperative fasting (12.3%). Most importantly, patients' comments were noted, when they were asked to suggest a better way to educate preoperatively in their respective area of dissatisfaction. Patients appreciated detailed explanations with practical demonstrations for range of motion exercises. One patient complained about no clear instructions on postoperative resumption of snuff. CONCLUSION: Preoperative patient education should be a two-way process involving active participation and continuous feedback. By educating patients properly through a multidisciplinary approach, healthcare providers can further enhance patient satisfaction, alleviate anxiety, and improve the overall quality of care.

Factorial Trial to Optimize an Internet-Delivered Intervention for Sexual Health After Breast Cancer: Protocol for the WF-2202 Sexual Health and Intimacy Enhancement (SHINE) Trial.

BACKGROUND: Although most survivors of breast cancer report substantial sexual concerns following treatment, few receive support for these concerns. Delivering sexual health care to survivors of breast cancer via the internet could overcome many of the barriers to in-person treatment. Even when delivered remotely, survivor time constraints remain a leading barrier to sexual health intervention uptake. OBJECTIVE: Guided by the multiphase optimization strategy methodological framework, the primary objective of this study is to identify the most efficient internet-delivered sexual health intervention package that is expected to provide survivors of breast cancer the greatest benefit with the fewest (and least-intensive) intervention components. This study aims to determine how intervention components work (mediators) and for whom they work best (moderators). METHODS: Partnered, posttreatment adult female survivors of breast cancer (N=320) experiencing at least 1 bothersome sexual symptom (ie, pain with sex, vaginal dryness, low sexual desire, and difficulty with orgasm) related to their breast cancer treatment will be enrolled. Clinic-based recruitment will be conducted via the Wake Forest National Cancer Institute Community Oncology Research Program (NCORP) Research Base. Participants will be randomly assigned to 1 of 16 combinations of four intervention components with two levels each in this factorial trial: (1) psychoeducation about cancer-related sexual morbidity (receive either enhanced vs standard versions); (2) communication skills training for discussing concerns with health care providers (received vs not received); (3) communication skills training for discussing concerns with a partner (received vs not received); and (4) intimacy promotion skills training (received vs not received). Cores will be fully automated and implemented using a robust internet intervention platform with highly engaging elements such as animation, video, and automated email prompts. Survivors will complete web-based assessments at baseline (prerandomization time point) and again at 12 and 24 weeks later. The primary study aim will be achieved through a decision-making process based on systematically evaluating the main and interaction effects of components on sexual distress (Female Sexual Distress Scale-Desire, Arousal, Orgasm) and sexual functioning (Female Sexual Function Index) using a generalized linear model approach to ANOVA with effect coding. Mediation analyses will be conducted through a structural equation modeling approach, and moderation analyses will be conducted by extending the generalized linear model to include interaction effects. RESULTS: This protocol has been reviewed and approved by the National Cancer Institute Central Institutional Review Board. Data collection is planned to begin in March 2024 and conclude in 2027. CONCLUSIONS: By identifying the combination of the fewest and least-intensive intervention components likely to provide survivors of breast cancer the greatest sexual health benefit, this study will result in the first internet intervention that is optimized for maximum impact on the undertreated, prevalent, and distressing problem of breast cancer-related sexual morbidity. TRIAL REGISTRATION: ClinicalTrials.gov NCT06216574; https://clinicaltrials.gov/study/NCT06216574. INTERNATIONAL REGISTERED REPORT IDENTIFIER (IRRID): PRR1-10.2196/57781.

Responding to Bias: Equipping Residents With Tools to Address Microaggressions.

Introduction: Resident physicians frequently experience bias at work, with patients and families often being the source. Women and other trainees underrepresented in medicine are disproportionately impacted by these negative experiences, and experiencing bias contributes to resident physician burnout. Unfortunately, many resident physicians feel inadequately prepared to respond to bias. Methods: We developed a 45-minute, peer-led, case-based workshop that equipped trainees with tools to respond to patient-expressed bias. Our toolkit centered on resident physicians by including an assessment of the trainee's emotional well-being, a team-based response, and an embedded debrief. The toolkit provided resident physicians with possible responses to bias directed towards themselves (bias-towards-self) or bias directed towards others (bias-towards-others). Surveys were administered pre- and postworkshop to assess change in participants' comfort in responding to patient-expressed bias. Results: Thirty-seven residents completed both surveys. The workshop significantly increased comfort in responding to bias-towards-self (p < .001; 95% CI, 1.00-1.50) and bias-towards-others (p < .001; 95% CI, 1.00-1.50). Discussion: We improved resident physicians' comfort responding to patient bias-towards-self and bias-towards-others through a toolkit and workshop designed specifically for trainees. The toolkit centers the resident physician perspective, incorporates clinical context, and embeds a debrief. Our novel approach situates the toolkit's teaching in a highly scalable, case-based workshop.