Faculty Bibliography

BACKGROUND:Primary care is pivotal to delivering effective healthcare. However, interest in primary care continues to decline; this is compounded by difficulties recruiting and retaining community-based preceptors to train and inspire trainees to enter primary care. Prior research explored the perspectives of community preceptors, but more concerted efforts across primary care specialties need to be directed upstream to understanding residents' perceptions on becoming future preceptors. OBJECTIVE:We aimed to understand the experiences and factors that shape graduating residents' attitudes about and desire to serve as outpatient preceptors. DESIGN/METHODS:This was a qualitative study, using a narrative inquiry approach, based on semi-structured interviews. PARTICIPANTS/METHODS:Graduating Internal Medicine, Pediatric, and Internal Medicine-Pediatric residents at a single institution were interviewed. APPROACH/METHODS:We developed an interview guide based on researchers' own experiences as medical educators and a pilot interview. Applying inductive analysis, we identified common themes that influenced participants' perspectives on outpatient precepting. With the derived themes, we identified an existing theory that best explained the results. KEY RESULTS/RESULTS:After interviewing 13 residents, four themes were constructed that influence participants' perspectives on becoming outpatient preceptors. The Theory of Planned Behavior, where one's intention is informed by one's behavioral beliefs, normative beliefs, and control beliefs, conceptualized the themes. Witnessed advantages and disadvantages of precepting informed participants' behavioral beliefs, preparedness to practice medicine and teach informed their control beliefs, physicians' responsibility to teach contributed to their normative beliefs, and clinical demands were a secondary determinant that influenced all three beliefs. CONCLUSIONS:Using identified themes and the Theory of Planned Behavior, we propose the following recommendations to improve resident outpatient training with the goal of improving long-term community preceptor recruitment: (1) enrich the outpatient learning experience, (2) reinforce the teacher identity, (3) advocate for structural and cultural changes to address current clinical barriers to teaching.

INTRODUCTION/UNASSIGNED:Sense of belonging is described by Anant as a "personal and contextually mediated experience." For medical students, their personal characteristics, patient care settings, and interactions with healthcare team members inform their perception of belonging. Students are designated as members of healthcare teams; however, feeling a sense of belonging, while necessary to achieve self-actualization, is not automatic. This study explored senior medical students' sense of belonging in patient care settings, specifically in their interactions with team members. METHODS/UNASSIGNED:In this qualitative study, investigators conducted focus groups with senior medical students at six institutions between February and May 2022. Investigators collected anonymous responses to reflective open-ended questions and demographics from participants at the close of each focus group. Author teams iteratively coded transcripts and written responses to generate themes. RESULTS/UNASSIGNED:Students' sense of belonging was influenced by interactions with team members that acknowledged shared experiences of stress and suffering, prioritized connection with team members, delineated expectations of students, and supported student autonomy, along with other contributors like physical spaces and team member characteristics. DISCUSSION/UNASSIGNED:This study explores interactions supporting medical students' sense of belonging in patient care settings. Results highlight the previously underreported contributions that collectively shared experiences of stress and suffering have on medical student belongingness. Participants' descriptions of experiences that promoted their sense of belonging form the basis for strategies to support a sense of belonging for medical students. These strategies may allow busy clinical teams to positively impact medical student belongingness.

BACKGROUND:Ritlecitinib, an oral JAK3/TEC family kinase inhibitor, demonstrated efficacy over 48 weeks in patients with alopecia areata (AA) in the ALLEGRO phase 2b/3 study. OBJECTIVES/OBJECTIVE:This post hoc analysis evaluated individual Severity of Alopecia Tool (SALT) score trajectories in patients who received ritlecitinib 50 mg and rolled over from Phase 2b/3 into the ongoing, open-label, Phase 3 ALLEGRO-LT study to describe long-term response patterns and associated baseline disease characteristics. METHODS:Patients aged ≥12 years with ≥50% scalp hair loss received ritlecitinib 50 mg once daily in both studies. SALT score trajectories from baseline to Month 24 were used to categorise patients as early (SALT score ≤20 at Week 24 and Months 12 and 24), middle (≤20 at Months 12 and 24) or late responders (≤20 by Month 24) or as partial responders (maintained 30% improvement), relapsers (achieved but did not maintain 30% improvement) or non-responders (did not achieve 30% improvement). The proportions of patients achieving sustained response (achieved and maintained SALT score ≤20 at all subsequent available time points through Month 24) and complete response (SALT score 0 at ≥1 time point through Month 24) were evaluated. Multivariable logistic regression assessed variables associated with response. RESULTS:Of 191 patients treated with ritlecitinib 50 mg, 87 (45.5%) were responders (SALT score ≤20), 24 (12.6%) were partial responders, 24 (12.6%) were relapsers and 56 (29.3%) were non-responders. Of 87 patients categorised as responders, 81 (93.1%) sustained their clinical response and 47 (46.0%) achieved complete response. Factors associated with treatment response included female sex and less extensive and shorter duration of hair loss. CONCLUSIONS:Approximately 45% of patients were SALT score responders, with up to 11% requiring >1 year of ritlecitinib treatment to achieve response, highlighting the importance of extended treatment duration. GOV REGISTRATION/UNASSIGNED:ALLEGRO phase 2b/3 study (NCT03732807); ALLEGRO-LT study (NCT04006457).

RATIONAL AND OBJECTIVE/OBJECTIVE:Formative feedback is an important strategy to improve resident learning. The purpose of our study is to evaluate the impact on frequency, quality and perceptions of resident formative feedback after implementation of a diagnostic breast imaging specific entrustable professional activity based mid-rotation checklist. MATERIAL AND METHODS/METHODS:In this IRB-approved multicenter study, a six-step methodology was used to develop the validated EPA based checklist, participant pre- and post-implementation surveys, and analyze the collected data. RESULTS:26 out of 32 (81%) residents and 7 out of 9 (78%) teaching attendings found the structured feedback checklist helpful in evaluating residents' performance on the diagnostic breast imaging rotation. 9 of 9 (100%) attending stated it improved their ability to give specific, timely, actionable and thoughtful feedback and 6 of 9 (67%) agreed that their feedback was more structured. 27 of 32 (84%) residents found that the feedback they received allowed them to tailor their studying to areas that needed improvement during the remainder of their rotation. CONCLUSION/CONCLUSIONS:Mid-rotation feedback using a structured EPA-based checklist improves the frequency and quality of resident formative feedback from both a residents' and attendings' perspective.

INTRODUCTION/UNASSIGNED:Medical students' accounts of gender bias in their patient care learning experiences remain limited. This study examines students' responses to gender bias and their consideration for how to prepare for gender bias in their futures. METHODS/UNASSIGNED:We analyzed reflective writings of third-year clinical students. Within a phenomenology framework, conventional content analysis was used to inductively analyze all essays, using HyperResearch software. We coded in teams and reconciled disagreements, then combined codes in categories to identify themes. RESULTS/UNASSIGNED:Sixty-seven students (39 females; 28 males) wrote about gender bias in patient encounters. We identified five themes: bias, context, students' responses to patients' bias, patient-centered approach, and preparation for future encounters. Observations of bias addressed gender and structural bias, sexism, and racism. Students reflected on how context framed their experiences. Students aimed for patient-centered care, while simultaneously feeling ambivalence regarding patients' expressed bias. Students described their need to prepare for future experiences of gender bias and their plans to use specific strategies to cope with this bias. DISCUSSION/UNASSIGNED:Our study offers the voices of medical students regarding gender bias in their clinical learning, presenting an important perspective, given an often-hierarchical system of medical education. This examination, which includes recommendations for curricula and policies, informs education leaders of the need to incorporate preparation for dealing with gender bias and to help students personally as they face challenging encounters with patients and medical teams. Enlightened by critical theories, these findings should also motivate resident and faculty development and promote critical inquiry for institutional changes.

JBJS convened a symposium to discuss the reporting of sex and gender in research studies as an imperative to improve research methods and results to benefit all patients. Barriers to improved reporting include a lack of societal and cultural acceptance of its need; a lack of education regarding appropriate terminology and appropriate statistical methods and efficient study designs; a need for increased research funding to support larger group sizes; unknown concordance of cell and animal models with humans to reflect biologic variables such as sex; and a lack of understanding of key considerations of gender, race, and other social determinants of health and how these factors intersect. Attention to developing and disseminating best-practice statistical methods and to educating investigators (at all career levels), reviewers, funders, editors, and staff in their proper implementation will aid reporting. Concomitantly, well-designed studies with sufficient rigor and adequate resources are essential to enable meaningful and reproducible research. Existing recommendations, such as the Sex and Gender Equity in Research (SAGER) guidelines, provide valuable guidance that can be applied across the research ecosystem. Academic institutions and private foundations are likely groups to assist in scientific and institutional review board guidance and study recruitment and pilot funding to generate meaningful power estimates, and to serve as sources for additional funding and presentation of workshops, educational events, and seminars. All of this needs to be conducted on an ongoing basis to ensure that sex and gender are considered in scientific analyses, where relevant.

Sex and gender impact all areas of health. However, they are not consistently considered in research design. The lack of a sufficient research base regarding the impacts of sex or gender affects the ability to develop health-care professional curricula that include this content for learners across the spectrum of experience. Teaching the importance of sex and gender is critical in training the next generations of health-care professionals and researchers. In addition to improving the current research base, there is a need to raise awareness of this topic among faculty and a need for additional faculty development materials. Learners, clinical faculty, researchers, journal reviewers, and journal leadership all play a role in improving the knowledge base regarding sex and gender and subsequently incorporating this information into curricula.

OBJECTIVE:To perform a qualitative content analysis of learning and assessment strategies that pediatric subinterns describe in Individualized Learning Plans (ILPs) and to explore barriers and facilitators to their learning. METHODS:We analyzed ILPs from medical students enrolled in pediatric subinternships at 10 US medical schools that utilized a standardized curriculum and were recruited to reflect diversity in geographic location, funding, and enrollment. Students used an ILP to record 3 or more selected learning objectives, rationale for selection, and reflection on learning and assessment strategies. Investigators used the constant comparative method to perform a content analysis of the ILPs, grouping codes into themes, and verifying relationships between codes within themes. RESULTS:Two hundred and four ILPs that included student reflections on 850 learning objectives were analyzed. Content was analyzed in 5 categories: rationale for selecting objectives, learning strategies, assessment strategies, challenges to learning, and facilitators of learning. Students showed strong commitment to individualized, self-directed learning, developed a wide range of creative learning strategies, and relied heavily on self-reflection to assess their progress. The learning environment both helped and hindered students' ability to make and assess progress on their selected learning objectives. CONCLUSIONS:Through ILP-guided reflection and a formal curriculum, students can choose well-justified learning objectives and demonstrate resourcefulness and independence in developing self-directed learning and assessment strategies. The strategies that students identified in this study provide a menu of learning and assessment options for subinterns. Identified challenges and facilitators of learning provide guidance for educators who seek to enhance the clinical learning environment.

INTRODUCTION/UNASSIGNED:Trainees and faculty in academic medicine often struggle with self-promotion. Barriers may be more formidable for women and other groups underrepresented in medicine. Experience-based stories illustrating personal strengths are preferable when engaging in self-promotion activities. METHODS/UNASSIGNED:) and free-response evaluations, which we analyzed for workshop strengths and areas for improvement. RESULTS/UNASSIGNED:= 4.7). Strengths included the PAR format, interactivity, journaling, opportunity for reflection, and tips for interviewing and writing. Areas to improve included offering the workshop earlier in the academic year and providing more written examples of PAR stories. DISCUSSION/UNASSIGNED:This workshop used strategies of personal reflection, journaling, and peer feedback to help participants understand behavior-based recruiting practices and the PAR framework as a strategy for successful self-promotion. Learners can use these strategies to develop greater confidence and efficacy and to address barriers to effective self-promotion they encounter.