Bowenbekker4550
The 11
revision of the International Classification of Diseases (ICD-11) includes a new diagnosis of complex posttraumatic stress disorder (CPTSD). The International Trauma Interview (ITI) is a novel clinician-administered diagnostic interview for the assessment of ICD-11 PTSD and CPTSD.
The aim of this study was to evaluate the psychometric properties of the ITI in a Lithuanian sample in relation to interrater agreement, latent structure, internal reliability, as well as convergent and discriminant validity.
In total, 103 adults with a history of various traumatic experiences participated in the study. The sample was predominantly female (83.5%), with a mean age of 32.64years (
=9.36). For the assessment of ICD-11 PTSD and CPTSD, the ITI and the self-report International Trauma Questionnaire (ITQ) were used. Mental health indicators, such as depression, anxiety, and dissociation, were measured using self-report questionnaires. The latent structure of the ITI was evaluated using confirmatory factor analysis (CFA). In order to test the convergent and discriminant validity of the ITI we conducted a structural equation model (SEM).
Overall, based on the ITI, 18.4% of participants fulfilled diagnostic criteria for PTSD and 21.4% for CPTSD. A second-order two-factor CFA model of the ITI PTSD and disturbances in self-organization (DSO) symptoms demonstrated a good fit. The associations with various mental health indicators supported the convergent and discriminant validity of the ITI. The clinician-administered ITI and self-report ITQ had poor to moderate diagnostic agreement across different symptom clusters.
The ITI is a reliable and valid tool for assessing and diagnosing ICD-11 PTSD and CPTSD.
The ITI is a reliable and valid tool for assessing and diagnosing ICD-11 PTSD and CPTSD.
Immigration detention is associated with detrimental mental health outcomes but little is known about the underlying psychological processes. Moral injury, the experience of transgression of moral beliefs, may play an important role.
Our aim was to explore moral injury appraisals and associated mental health outcomes related to immigration detention on Nauru.
In this retrospective study, we conducted in-depth interviews with 13 individuals who had sought refuge in Australia and, due to arriving by boat, had been transferred to immigration detention on Nauru. At the time of the study, they lived in Australia following medical transfer. We used reflexive thematic analysis to develop themes from the data.
Major themes included 1) how participants' home country experience and the expectation to get protection led them to seek safety in Australia; 2) how they experienced deprivation, lack of agency, violence, and dehumanization after arrival, with the Australian government seen as the driving force behind ion may benefit from interventions that specifically target moral injury, collective steps are needed to diminish deterioration of refugee mental health. Our results highlight the potentially deleterious mental health impact of experiencing multiple subtle and substantial transgressions of one's moral frameworks. Policy makers should incorporate moral injury considerations to prevent eroding refugee mental health.[This corrects the article DOI 10.1140/epjs/s11734-022-00454-4.].
The 2020-2021 residency application cycle was altered to reduce COVID-19 transmission, with moves to all virtual interviews and no away rotations for medical students. These changes may have affected how students ranked residency programs, such as choosing programs near their medical schools.
To determine if a larger percentage of medical students matched to residency programs in the same state as their medical schools in 2021 vs 2018-2020.
We searched the webpages or emailed student affairs deans of the 155 Liaison Committee on Medical Education accredited MD programs to attain medical school match lists. Differences in the percentage of students matching to residency programs in the same US state as their medical schools in 2021 vs 2018-2020 were compared using chi-square tests.
We recorded 36 021 of 79 406 (45%) National Resident Matching Program, 759 of 1720 (44%) ophthalmology, and 586 urology MD residency matches between 2018 and 2021. The percentage of students matching to residency programs in the same state as their medical schools was 35.9% in 2021 versus 34.3% in 2018-2020 (
=.005). Students were more likely to match to programs in the same state as their medical schools in 2021 if they attended a public medical school (40.3% vs 38.5%,
=.009) or applied into specialties where ≥50% of students traditionally perform away rotations (32.2% vs 30.2%,
=.031).
There was a small difference in the percentage of medical students matching to residency programs in the same state as their medical schools in 2021 vs 2018-2020.
There was a small difference in the percentage of medical students matching to residency programs in the same state as their medical schools in 2021 vs 2018-2020.
Little outcome data exist on 3-year MD (3YMD) programs to guide residency program directors (PDs) in deciding whether to select these graduates for their programs.
To compare performance outcomes of 3YMD and 4-year MD (4YMD) students at New York University Grossman School of Medicine.
In 2020, using the Kirkpatrick 4-level evaluation model, outcomes from 3 graduating cohorts of 3YMD students (2016-2018) were compared with the 4YMD counterparts.
Descriptive statistics compared outcomes among consented student cohorts 92% (49 of 53) 3YMD, 87% (399 of 459) 4YMD-G, and 84% (367 of 437) 4YMD-S. Student survey response rates were 93% (14 of 15), 74% (14 of 19), and 89% (17 of 19) from 2016 to 2018. PDs' response rates were 58% (31 of 53, 3YMD) and 51% (225 of 441, 4YMD). Besides age, 3YMD and 4YMD cohorts did not differ significantly in admissions variables. Other than small statistically significant differences in the medicine shelf examination (3YMD mean 74.67, SD 7.81 vs 4YMD-G mean 78.18, SD 7.60;
test=3.02;
=.003) and USMLE Step 1 (3YMD mean 235.13, SD 17.61 vs 4YMD-S mean 241.70, SD 15.92;
test=2.644;
=.009 and vs 4YMD-G mean 242.39, SD 15.65;
test=2.97;
=.003) and Step 2 CK scores (3YMD mean 242.57, SD 15.58 vs 4YMD-S mean 248.55, SD 15.33;
test=2.55;
=.01 and vs 4YMD-G mean 247.83, SD 15.38;
test=2.97;
=.03), other metrics and overall intern ratings did not differ by pathway.
Exploratory findings from a single institution suggest that 3YMD students performed similarly to 4YMD students in medical school and the first year of residency.
Exploratory findings from a single institution suggest that 3YMD students performed similarly to 4YMD students in medical school and the first year of residency.
The Junior Attending (JA) role is an educational model, commonly implemented in the final years of training, wherein a very senior resident assumes the responsibilities of an attending physician under supervision. However, there is heterogeneity in the model's structure, and data are lacking on how it facilitates transition to independent practice.
The authors sought to determine the value of the JA role and factors that enabled a successful experience.
The authors performed a collective case study informed by a constructivist grounded theory analytical approach. Twenty semi-structured interviews from 2017 to 2020 were conducted across 2 cases (1) Most Responsible Physician JA role (general internal medicine), and (2) Consultant JA role (infectious diseases and rheumatology). Participants included recent graduates who experienced the JA role, supervising attendings, and resident and faculty physicians who had not experienced or supervised the role.
Experiencing the JA role builds resident confidence and may support the transition to independent practice, mainly in non-medical expert domains, as well as comfort in dealing with clinical uncertainty. The relationship between the supervising attending and the JA is an essential success factor, with more productive experiences reported when there is an establishment of clear goals and role definition that preserves the autonomy of the JA and legitimizes the JA's status as a team leader.
The JA model offers promise in supporting the transition to independent practice when key success factors are present.
The JA model offers promise in supporting the transition to independent practice when key success factors are present.
The Accreditation Council for Graduate Medical Education mandates residents incorporate cost considerations into patient care. However, resident experiences with high-value care (HVC) in the clinical setting have not been well described.
To explore pediatric residents' experiences with HVC and its facilitators and barriers.
We performed a qualitative study with a grounded theory epistemology of pediatric residents recruited by email at a large academic children's hospital. We conducted focus groups (n=3) and interviews (n=7) between February and September 2020 using a semi-structured guide. Data were analyzed using the constant comparative method. Codes were built using an iterative approach and organized into thematic categories. Sampling continued until saturation was reached.
Twenty-two residents participated. Residents' value-based health care decisions occurred in a complex learning environment. Due to limited experience, residents feared missing diagnoses, which contributed to perceived overtesting. Resident autonomy, with valuable experiential learning, supported and hindered HVC. Informal teaching occurred through patient care discussions; however, cost information was lacking. Practice of HVC varied by clinical setting with greater challenges on high acuity and subspecialty services. For children with medical complexity, identifying family concerns and goals of care improved value. Family experience/demands influenced resident health care decisions, contributing to high- and low-value care. Effective collaboration among health care team members was crucial; residents often felt pressured following perceived low-value recommendations from consultants.
Resident HVC learning and practice is influenced by multiple factors in a complex clinical learning environment.
Resident HVC learning and practice is influenced by multiple factors in a complex clinical learning environment.
Narrative feedback, like verbal feedback, is essential to learning. Regardless of form, all feedback should be of high quality. This is becoming even more important as programs incorporate narrative feedback into the constellation of evidence used for summative decision-making. Continuously improving the quality of narrative feedback requires tools for evaluating it, and time to score. A tool is needed that does not require clinical educator expertise so scoring can be delegated to others.
To develop an evidence-based tool to evaluate the quality of documented feedback that could be reliably used by clinical educators and non-experts.
Following a literature review to identify elements of high-quality feedback, an expert consensus panel developed the scoring tool. Aminocaproic Messick's unified concept of construct validity guided the collection of validity evidence throughout development and piloting (2013-2020).
The Evaluation of Feedback Captured Tool (EFeCT) contains 5 categories considered to be essential elements of high-quality feedback.
