Effects of a Rice-Farming Simulation Video Game on Nature Relatedness, Nutritional Status, and Psychological State in Urban-Dwelling Adults During the COVID-19 Pandemic: Randomized Waitlist Controlled Trial.

BACKGROUND: During the COVID-19 pandemic, urban inhabitants faced significant challenges in maintaining connections with nature, adhering to nutritional guidelines, and managing mental well-being. OBJECTIVE: Recognizing the urgent need for innovative approaches, this study was designed to explore the potential benefits of a specific digital intervention, the rice-farming simulation game Sakuna: Of Rice and Ruin, for nature relatedness, nutritional behaviors, and psychological well-being. METHODS: A total of 66 adults without any prior major psychiatric disorders residing in an urban area were recruited for the study. They were randomly assigned to 2 groups through block randomization: the immediate intervention group (IIG; 34/66, 52%) and the waitlist group (32/66, 48%). Participants in the IIG were instructed to play the game for at least 4 days per week for 3 weeks, with each session lasting from 30 minutes to 3 hours. Assessments were performed at baseline, week 1, and week 3. The Nature Relatedness Scale (NR) and Nutrition Quotient Scale were used to evaluate nature relatedness and nutritional state, respectively. Furthermore, psychological state was assessed using the World Health Organization Quality of Life-Brief Version (WHOQOL-BREF), Brief Fear of Negative Evaluation Scale, Social Avoidance and Distress Scale, Toronto Alexithymia Scale, State-Trait Anxiety Inventory, Center for Epidemiologic Studies Depression Scale Revised, and Korean Resilience Quotient. RESULTS: This study's results revealed significant time interactions between the IIG and waitlist group for both the total NR score (P=.001) and the score of the self subdomain of NR (P<.001), indicating an impact of the game on nature relatedness. No group×time interactions were found for the total Nutrition Quotient Scale and subdomain scores, although both groups showed increases from baseline. For psychological state, a significant group×time interaction was observed in the total WHOQOL-BREF score (P=.049), suggesting an impact of the game on quality of life. The psychological (P=.01), social (P=.003), and environmental (P=.04) subdomains of the WHOQOL-BREF showed only a significant time effect. Other psychological scales did not display any significant changes (all P>.05). CONCLUSIONS: Our findings suggest that the rice-farming game intervention might have positive effects on nature relatedness, nature-friendly dietary behaviors, quality of life, anxiety, depression, interpersonal relationships, and resilience among urban adults during the COVID-19 pandemic. The impact of pronature games in confined urban environments provides valuable evidence of how digital technologies can be used to enhance urban residents' affinity for nature and psychological well-being. This understanding can be extended in the future to other digital platforms, such as metaverses. TRIAL REGISTRATION: Clinical Research Information Service (CRIS) KCT0007657; http://tinyurl.com/yck7zxp7.

Validation of a Modified Version of Interpersonal Reactivity Index for Medical Students Using Rasch Analysis.

Construct: Empathy has been accepted to interweave both cognitive aspects (the ability to put oneself in another person's place), and affective (or emotional) aspects, indicating an emotional reaction or response to another person's emotional state. Literature supports the positive influences of empathy on doctor-patient relationship, patient satisfaction, and positive clinical outcomes. Background: Many studies have dealt with the development of empathy measurement tools for physicians and medical students. A frequently used empathy measuring instrument for medical students is the "Interpersonal Reactivity Index" (IRI) which was designed to measure the multi-dimensional aspects of empathy in the general adult population. Most previous literature which validated IRI for medical students has used factor analysis, whilst studies applying Rasch models have been limited. Our study aimed to investigate the psychometric properties of a modified version of IRI for medical students using Rasch analysis. Approach: Medical students (1,293) from 15 medical schools in South Korea participated in an online questionnaire consisting of 28 items of the Korean translated version of IRI. We applied exploratory factor analysis (EFA) using polychoric correlation matrix to determine the optimal number of factors followed by Rasch analysis and McDonald's Omega calculation. Findings: The adapted IRI-MS (IRI for medical students) consisted of 17 items in four dimensions: empathic concern (5), fictitious situation (4), perspective taking (4), and personal distress (4). The overall fit of IRI-MS revealed an acceptable goodness-of-fit for all 17 items and a positive point measure correlation for all items. Reliability indices from the Rasch modeling and McDonald's Omega values of all four dimensions were satisfactory for research. We found the Wright-Andrich maps and category probability curves of the IRI's four dimensions to be less than optimal in measuring empathy levels with adequate precision. Conclusions: Rasch analysis of IRI-MS fell short from being able to prove satisfactory validity in measuring the multidimensional nature of empathy in medical students. However, our study applying Rasch analysis may serve as groundwork for future studies, to further develop from the shortcomings of our findings.Supplemental data for this article are available online at at www.tandfonline.com/htlm .

Burnout of Faculty Members of Medical Schools in Korea.

BACKGROUND: There is no national survey on medical school faculty members' burnout in Korea. This study aimed to investigate burnout levels and explore possible factors related to burnout among faculty members of Korean medical schools. METHODS: An anonymous online questionnaire was distributed to 40 Korean medical schools from October 2020 to December 2020. Burnout was measured by a modified and revalidated version of the Maslach Burnout Inventory-Human Service Survey. RESULTS: A total of 996 faculty members participated in the survey. Of them, 855 answered the burnout questions, and 829 completed all the questions in the questionnaire. A significant number of faculty members showed a high level of burnout in each sub-dimension: 34% in emotional exhaustion, 66.3% in depersonalization, and 92.4% in reduced personal accomplishment. A total of 31.5% of faculty members revealed a high level of burnout in two sub-dimensions, while 30.5% revealed a high level of burnout in all three sub-dimensions. Woman faculty members or those younger than 40 reported significantly higher emotional exhaustion and depersonalization. Long working hours (≥ 80 hours/week) showed the highest reduced personal accomplishment scores (F = 4.023, P = 0.018). The most significant stressor or burnout source was "excessive regulation by the government or university." The research was the most exasperating task, but the education was the least stressful. CONCLUSION: This first nationwide study alerts that a significant number of faculty members in Korean medical schools seem to suffer from a high level of burnout. Further studies are necessary for identifying the burnout rate, related factors, and strategies to overcome physician burnout.

Differences in empathy toward patients between medical and nonmedical students: an fMRI study.

There is growing concern about a potential decline in empathy among medical students over time. Despite the importance of empathy toward patients in medicine, it remains unclear the nature of the changes in empathy among medical students. Thus, we systematically investigated affective and cognitive empathy for patients among medical students using neuroscientific approach. Nineteen medical students who completed their fifth-year medical curriculum and 23 age- and sex-matched nonmedical students participated in a functional magnetic resonance imaging study. Inside a brain scanner, all participants read empathy-eliciting scenarios while adopting either the patient or doctor perspective. Brain activation and self-reported ratings during the experience of empathy were obtained. Behavioral results indicated that all participants reported greater emotional negativity and empathic concern in association with the patient perspective condition than with the doctor perspective condition. Functional brain imaging results indicated that neural activity in the posterior superior temporal region implicated in goal-relevant attention reorienting was overall increased under the patient perspective than the doctor perspective condition. Relative to nonmedical students, medical students showed decreased activity in the temporoparietal region implicated in mentalizing under the patient perspective versus doctor perspective condition. Notably, this same region showed increased activity under the doctor versus patient condition in medical students relative to nonmedical students. This study is among the first to investigate the neural mechanisms of empathy among medical students and the current findings point to the cognitive empathy system as the locus of the primary brain differences associated with empathy toward patients.

Adaptations in Anatomy Education during COVID-19.

BACKGROUND: The impact of coronavirus disease 2019 (COVID-19) has profoundly affected education, with most universities changing face-to-face classes to online formats. To adapt to the COVID-19 pandemic situation, we adopted a blended learning approach to anatomy instruction that included online lectures, pre-recorded laboratory dissection videos, and 3D anatomy applications, with condensed offline cadaver dissection. METHODS: We aimed to examine the learning outcomes of a newly adopted anatomy educational approach by 1) comparing academic achievement between the blended learning group (the 2020 class, 108 students) and the traditional classroom learning group (the 2019 class, 104 students), and 2) an online questionnaire survey on student preference on the learning method and reasons of preference. RESULTS: The average anatomy examination scores of the 2020 class, who took online lectures and blended dissection laboratories, were significantly higher than those of the 2019 class, who participated in an offline lecture and dissection laboratories. The questionnaire survey revealed that students preferred online lectures over traditional large group lecture-based teaching because it allowed them to acquire increased self-study time, study according to their individual learning styles, and repeatedly review lecture videos. CONCLUSION: This study suggests that a blended learning approach is an effective method for anatomy learning, and the advantage may result from increased self-directed study through online learning.

A Preliminary Study on Uncovering Medical Students' Unprofessional Behaviors from YouTube Videos.

Creation of guidelines and education on digital professionalism have been sluggish despite the ever-increasing use of social media by digitally native medical students, who are at risk of blurring the line between their professional and personal lives online. A qualitative thematic analysis was applied on 79 videos extracted from 70,154 YouTube videos uploaded by Korean medical students between March and April 2020. We found 20% contained at least one concerning behavior themed under 'failure to engage,' 'disrespectful behaviors,' or 'poor self-awareness.' Professional lapses identified were classified into seriousness levels. Mostly were "controversial' or 'concerning' but some 'highly concerning' contents were also found. This is the first study on digital professionalism behavior on medical students' YouTube videos. The potential negative impact on the medical profession of the easily accessible public online videos cannot be ignored and thus we suggest the need for them to be taken more seriously.

Lessons from Cadaver Dissection during the COVID-19 Pandemic.

The rapid increase of the coronavirus disease 2019 pandemic from mid-February 2020 has led the anatomy department of the Korea University College of Medicine to cease the dissection laboratory. However, the hands-on anatomy laboratory experience is paramount to maximizing learning outcomes. In this paper, we share the experiences and lessons learned through the face-to-face cadaveric dissection experience during this disruptive situation. To minimize infection risks, the following strategies were applied: first, students' on-campus attendance was reduced; second, body temperatures and symptoms were checked before entering the laboratory, and personal protective equipment was provided to all participants; and third, a negative pressure air circulation system was used in the dissection room. We suggest that conducting face-to-face cadaveric anatomy dissection is feasible when the daily count of newly infected cases stabilizes, and there is ample provision of safety measures to facilitate hands-on education.

Assessing the effects of an empathy education program using psychometric instruments and brain fMRI.

This study aimed to (1) evaluate the effects of an empathy education program, and (2) explore functional magnetic resonance imaging (fMRI) as a potential empathy assessment tool. An empathy enhancement program for premedical students was developed. The Korean version of the Jefferson Scale of Empathy-Student version (JSE-S) and Interpersonal Reactivity Index (K-IRI) were used to measure self-assessed changes in empathy. Clinical vignettes demonstrating empathy tasks were presented to participants undergoing fMRI, to assess regional changes in the brain. Self-reported empathy scores and brain activity signals using fMRI from before and after the program were compared. The JSE-S total and perspective taking scores significantly increased after the program. Data from the fMRI revealed noticeable differences in cognitive regions associated with empathy, namely the right superior medial frontal gyrus and left precentral gyrus. This study results support the prior evidence of positive impact of empathy education. In addition, the authors suggest that brain fMRI might be used in measuring the effectiveness of empathy education.

Correction to: Assessing the effects of an empathy education program using psychometric instruments and brain fMRI.

Due to an unfortunate turn of events, the funding note was omitted from the original publication. The correct funding note is published here and should be treated as definitive.

Effects of food availability on growth performance and immune-related gene expression of juvenile olive flounder (Paralichthys olivaceus).

Unfavorable environmental conditions and inappropriate culture practices have increased the vulnerability of cultured fish to disease infection. Up to date many studies have aimed to determine a feeding regimen to maximize productivity; however, very little information on immune responses of cultured fish in response to underfeeding or overfeeding is available. Therefore, a preliminary study was conducted to evaluate effects of graded feeding levels (i.e., food availability) on growth performance and immune-related gene expression of juvenile olive flounder (Paralichthys olivaceus). Six different feeding rates including 1, 4, 7, 10, 13, and 16% body weight per day (BW/d) were randomly assigned to three replicate tanks stocking 150 fish (average initial body weight: 0.27 ±â€¯0.02 g; mean ±â€¯SD) per tank. A feeding trial lasted for two weeks. Based on the results of the weight gain, nutrient gain, and whole-body compositions and energy content, the feeding rate of 10%, 13%, and 16% BW/d resulted in high nutritional status, whereas the feeding rate of 1% and 4% BW/d resulted in low nutritional status. Intermediate nutritional status was observed at the feeding rate of 7% BW/d. In the given rearing conditions the optimum feeding rate resulting in the maximum growth was estimated to be 11.9% BW/d based on the quadratic broken-line regression model, chosen as the best-fit model among the tested models. Expression of immune-related genes including IL-8 and IgM was significantly down-regulated in the flounder fed at 1% BW/d in comparison to those fed at 7% BW/d. Interestingly, expression of these genes in the flounder fed at 10%, 13%, and 16% BW/d was relatively down-regulated in comparison to that of the flounder fed at 7% BW/d. Although no statistical difference was detected, overall response patterns of other immune-related genes, including TLR3, polymeric Ig receptor, lysozyme C-type, GPx, SOD, and Trx followed what IL-8 and IgM exhibited in response to the various feeding rates. Given the current challenges in aquaculture of the flounder our findings suggest to prohibit underfeeding or overfeeding (i.e., ad-libitum feeding) when culturing the young flounder.

Emotional experiences of medical students during cadaver dissection and the role of memorial ceremonies: a qualitative study.

BACKGROUND: It has been well reported that the emotional experiences of medical students in the gross anatomy laboratory could have significant impacts on their professional identity formation. This qualitative study aimed to investigate students' emotions towards cadaver dissection and the educational role of memorial ceremonies. METHODS: A total of 37 students from eight teams were recruited in the team-based dissection course during two consecutive academic years (2016 and 2017) at one medical school. In focus group interviews, students were encouraged to express and discuss their emotions regarding cadaver dissection and memorial ceremonies. RESULTS: The participants described their apprehension and anxiety during their first encounter with cadavers that diminished through gradual exposure. Unfortunately, their positive emotions such as gratitude and responsibility also tended to decline under the pressure of excessive workloads and frequent examinations. Memorial ceremonies, including not only large-scale events but also daily rituals, had educational effects that they prevented the decline of students' responsibility and respect during the dissection course. CONCLUSION: Educators should assist medical students in overcoming their initial distress and maintaining respectful attitudes throughout the dissection course. Memorial ceremonies can be effective educational tools for fostering appropriate attitudes and ethical practice in the gross anatomy laboratory.

Causes of resident lapses in professional conduct during the training: A qualitative study on the perspectives of residents.

BACKGROUND: The residency is a critical period for doctors to establish their professional identity and ethical standards, and yet during this time, residents are susceptible to engage in a diverse range of unprofessional behaviors. To prevent the misconduct of residents, it is critical to have a thorough understanding of the contributing factors or circumstances. METHODS: We conducted a qualitative study on 20 residents at one Korean university-affiliated tertiary hospital. During in-depth interviews, residents were asked to reveal their experiences or observations of misconduct, and describe their perceptions on the attributes of professional lapses. RESULTS: Diverse unethical and unprofessional behaviors were extracted from the transcripts and reported in a previous paper. In the current paper, the attributes that residents regarded as the causes of their unprofessional behaviors were identified within four categories: (1) inadequate systems within training hospitals; (2) lack of professionalism education; (3) strong hierarchical structure; and (4) poor character of individuals. The residents tended to perceive their misconduct as situation-sensitive, and emphasized the importance of systematic and cultural changes. CONCLUSIONS: To enhance medical professionalism among residents, the results of this study suggest the need of systematic and structured training programs, adequate professionalism education with clear codes of conduct, and active monitoring and feedback systems.

Individual, interpersonal, and organisational factors of healthcare conflict: A scoping review.

Unresolved conflicts among healthcare professionals can lead to difficult patient care consequences. This scoping review examines the current healthcare literature that reported sources and consequences of conflict associated with individual, interpersonal, and organisational factors. We identified 99 articles published between 2001 and 2015 from PubMed, Cumulative Index to Nursing and Allied Health Literature, and Excerpta Medical Database. Most reviewed studies relied on healthcare professionals' perceptions and beliefs associated with conflict sources and consequences, with few studies reporting behavioural or organisational change outcomes. Individual conflict sources included personal traits, such as self-focus, self-esteem, or worldview, as well as individuals' conflict management styles. These conflicts posed threats to one's physical, mental, and emotional health and to one's ability to perform at work. Interpersonal dynamics were hampered by colleagues' uncivil behaviours, such as low degree of support, to more destructive behaviours including bullying or humiliation. Perceptions of disrespectful working environment and weakened team collaboration were the main interpersonal conflict consequences. Organisational conflict sources included ambiguity in professional roles, scope of practice, reporting structure, or workflows, negatively affecting healthcare professionals' job satisfactions and intent to stay. Future inquiries into healthcare conflict research may target the following: shifting from research involving single professions to multiple professions; dissemination of studies via journals that promote interprofessional research; inquiries into the roles of unconscious or implicit bias, or psychological capital (i.e., resilience) in healthcare conflict; and diversification of data sources to include hospital or clinic data with implications for conflict sources.

The effects of Tai Chi on waist circumference and blood pressure in the elderly.

[Purpose] The purpose of this study was to investigate the effects of Tai Chi on waist circumference and blood pressure in the elderly. The present study used a nonequivalent control group pretest-posttest design. [Subjects and Methods] Sixty-eight elderly individuals residing in J city were divided into 2 groups: 34 in the experimental group, who received Tai Chi training for 6 weeks, and 34 in the control group, who did not receive Tai Chi training. Simplified Yang style 24-form Tai Chi was used as the intervention, which was conducted for 60 minutes per session, 5 sessions per week, for a total of 6 weeks. In each session, subjects in the experimental group conducted 10 minutes of warm-up exercises, 45 minutes of Tai Chi, and 5 minutes of cool-down exercises. Waist circumference and blood pressure were measured before and after the 6-week intervention. [Results] Waist circumference and blood pressure decreased significantly after the 6-week intervention in the experimental group compared with the control group. [Conclusion] Tai Chi can be used as an effective intervention to improve waist circumference and blood pressure in the elderly.

Ribosomal P3 protein AtP3B of Arabidopsis acts as both protein and RNA chaperone to increase tolerance of heat and cold stresses.

The P3 proteins are plant-specific ribosomal P-proteins; however, their molecular functions have not been characterized. In a screen for components of heat-stable high-molecular weight (HMW) complexes, we isolated the P3 protein AtP3B from heat-treated Arabidopsis suspension cultures. By size-exclusion chromatography (SEC), SDS-PAGE and native PAGE followed by immunoblotting with anti-AtP3B antibody, we showed that AtP3B was stably retained in HMW complexes following heat shock. The level of AtP3B mRNA increased in response to both high- and low-temperature stresses. Bacterially expressed recombinant AtP3B protein exhibited both protein and RNA chaperone activities. Knockdown of AtP3B by RNAi made plants sensitive to both high- and low-temperature stresses, whereas overexpression of AtP3B increased tolerance of both conditions. Together, our results suggest that AtP3B protects cells against both high- and low-temperature stresses. These findings provide novel insight into the molecular functions and in vivo roles of acidic ribosomal P-proteins, thereby expanding our knowledge of the protein production machinery.

A functional neuroimaging study of the clinical reasoning of medical students.

As clinical reasoning is a fundamental competence of physicians for good clinical practices, medical academics have endeavored to teach reasoning skills to undergraduate students. However, our current understanding of student-level clinical reasoning is limited, mainly because of the lack of evaluation tools for this internal cognitive process. This functional magnetic resonance imaging (fMRI) study aimed to examine the clinical reasoning processes of medical students in response to problem-solving questions. We recruited 24 2nd-year medical students who had completed their preclinical curriculum. They answered 40 clinical vignette-based multiple-choice questions during fMRI scanning. We compared the imaging data for 20 problem-solving questions (reasoning task) and 20 recall questions (recall task). Compared to the recall task, the reasoning task resulted in significantly greater activation in nine brain regions, including the dorsolateral prefrontal cortex and inferior parietal cortex, which are known to be associated with executive function and deductive reasoning. During the recall task, significant activation was observed in the brain regions that are related to memory and emotions, including the amygdala and ventromedial prefrontal cortex. Our results support that medical students mainly solve clinical questions with deductive reasoning involving prior knowledge structures and executive functions. The problem-solving questions induced the students to utilize higher cognitive functions compared with the recall questions. Interestingly, the results suggested that the students experienced some emotional distress while they were solving the recall questions. In addition, these results suggest that fMRI is a promising research tool for investigating students' cognitive processes.

Investigation of Unethical and Unprofessional Behavior in Korean Residency Training.

UNLABELLED: PHENOMENON: Medical ethics and professionalism are fundamental competencies for all physicians, and resident physicians have to develop these competencies during their training. Although Korea has a reputation for having the highest quality medical practice in East Asia, improvements in the technological aspects of care have outpaced the developments in institutional systems and education needed to fulfill social responsibility. Enhancing professionalism education during postgraduate training requires thorough exposition of this situation. APPROACH: Twenty residents from 17 clinical departments at 1 Korean tertiary university-affiliated hospital were recruited, and in-depth interviews were conducted in person by an interviewer who was a fellow resident with participants. Interviewees recalled and described personal experiences or observations of misbehaviors that had occurred during their residency training. Researchers recorded and transcribed all interviews, and 4 researchers conducted a thematic analysis. FINDINGS: Authors extracted 48 descriptors representing 8 categories of unethical and unprofessional behaviors from the transcripts: (a) substandard practice, (b) violation of work ethics, (c) misconduct related to conflict of interest, (d) dishonesty with patients, (e) violation of patient confidentiality, (f) lack of respect for patients, (g) lack of respect for colleagues, and (h) misconduct in research. Each of the interviewees mentioned between 3 and 18 descriptors. "Not fulfilling basic duties for patient care" was the most frequently mentioned misconduct, followed by "fabricating patient medical status or test results to meet preoperative criteria for anesthesia" and "verbal or physical abuse of junior doctors." INSIGHTS: Residents reported a diverse variety of unethical and unprofessional behaviors throughout their training and described the ethical distress they suffered in the real clinical situations. The results of this study support the notion that reinforcing ethics and professionalism education during postgraduate medical training in a practical and authentic way will help trainees manage the ethical conflicts or dilemmas they will inevitably encounter.

Scoping review: exploring residents' views of supervisor entrustment and its effect on learning and professional development.

This scoping review aimed to systematically explore the complex and nuanced perceptions of residents entrusted with significant responsibilities by their supervisors in the clinical context. We conducted a comprehensive search strategy targeting six major electronic databases. Data were extracted using the PRISMA-ScR (Preferred Reporting Items for Systematic Reviews and Meta-Analyses extension for Scoping Reviews) checklist and a scoping review protocol. Resident perceptions regarding entrustment and its impact on learning and professional development were categorized. This review elucidated the role of supervisor entrustment in shaping residents' clinical performance, notably influencing autonomy, self-confidence, responsibility for patients, learning needs and goals, uncertainty management, and professional identity formation. Residents identified factors that promote and hinder performance and entrustment development resulting from supervisor entrustment and distinguished between appropriate supervision and over- or under-supervision. Our review suggests that residents' perceptions of supervisor entrustment, as bestowed by supervisors, serves as a catalyst for enhancing autonomy, thereby exerting a significant influence on clinical performance, and fostering the development of a professional identity. However, residents' views on appropriate supervision differ in some ways from supervisors' perspectives. Further research is needed to bridge the gap between residents' expectations of autonomy and what they are given, and to explore the intricate relationship between autonomy and entrustment.