Integration of Psychological Services With Preventive Cardiology Consults: A Feasibility Study.

Psychological distress can have a significant impact on cardiovascular disease (CVD) and efforts to treat psychological distress may improve CVD risk factors. Therefore, we conducted a retrospective feasibility of implementation study to assess the utilization of short-term psychotherapy in patients engaged in a cardiovascular prevention program. Participants included patients engaged in the Women's Health or Preventive Cardiology programs from January 2019 to June 2022.

Stepping Back: How Should Pass/Fail Scoring Influence Step 1 Timing?

Although most students complete Step 1 before clerkships, some institutions delay the exam until after clerkships. The change to pass/fail grading adds additional complexity that should be considered when deciding about exam timing. Both early and late administration may affect learning outcomes, learner behavior, student well-being, and residency match success.

Better Care, Same Cost - Reducing Unplanned Care for Multi-visit Patients: A Payer-Provider Model.

Importance: Many interventions implemented for multi-visit patients (MVP) have been developed to address patient-centric needs of these individuals and reduce unplanned care for ambulatory-sensitive conditions. More rigorous research is needed to better understand the impact of these interventions on changes in care utilization including unplanned care.

Objective: To evaluate the impact of the Enhanced Care Program (ECP), a payer-provider collaborative model, on unplanned care use and cost of care.

Leveraging data to support health equity in an integrated delivery and finance system.

Introduction: To accelerate healthcare transformation and advance health equity, scientists in learning health systems (LHSs) require ready access to integrated, comprehensive data that includes information on social determinants of health (SDOH).

Methods: We describe how an integrated delivery and finance system leveraged its learning ecosystem to advance health equity through (a) a cross-sector initiative to integrate healthcare and human services data for better meeting clients' holistic needs and (b) a system-level initiative to collect and use patient-reported SDOH data for connecting patients to needed resources.

Results: Through these initiatives, we strengthened our health system's capacity to meet diverse patient needs, address health disparities, and improve health outcomes.

Learning enhances representations of taste-guided decisions in the mouse gustatory insular cortex.

Learning to discriminate overlapping gustatory stimuli that predict distinct outcomes-a feat known as discrimination learning-can mean the difference between ingesting a poison or a nutritive meal. Despite the obvious importance of this process, very little is known about the neural basis of taste discrimination learning. In other sensory modalities, this form of learning can be mediated by either the sharpening of sensory representations or the enhanced ability of "decision-making" circuits to interpret sensory information.

Racial and Ethnic Bias in Letters of Recommendation in Academic Medicine: A Systematic Review.

Purpose: Letters of recommendations (LORs) are key components of academic medicine applications. Given that bias against students and trainees underrepresented in medicine (UIM) has been demonstrated across assessment, achievement, and advancement domains, the authors reviewed studies on LORs to assess racial, ethnic, and UIM differences in LORs. Standardized LORs (SLORs), an increasingly common form of LORs, were also assessed for racial and ethnic differences.

"I Was Told to Think Like a Middle-Aged White Woman": A Survey on Identity and the Association of Social Work Boards Exam.

The release of the 2022 Association of Social Work Boards (ASWB) exam passage rate report confirmed what many test takers who failed their exam believe. The ASWB exams are biased, with differential passage rates based on the test taker's race, age, and "English as a second language" status. However, the report only offered basic descriptive statistics and lacked insight into the test takers' experience.

Accuracy of Entrustment-Based Assessment: Implications for Programs and Patients.

Although entrustment-supervision ratings are more intuitive compared to other rating scales, it is not known whether their use accurately assesses the appropriateness of care provided by a resident. To determine the frequency of incorrect entrustment ratings assigned by faculty and whether accuracy of an entrustment-supervision scale differed by resident performance when the scripted resident performance level is known. Faculty participants rated standardized residents in 10 videos using a 4-point entrustment-supervision scale.

Gender Differences in Work-Based Assessment Scores and Narrative Comments After Direct Observation.

Background: While some prior studies of work-based assessment (WBA) numeric ratings have not shown gender differences, they have been unable to account for the true performance of the resident or explore narrative differences by gender.

Objective: To explore gender differences in WBA ratings as well as narrative comments (when scripted performance was known).

Design: Secondary analysis of WBAs obtained from a randomized controlled trial of a longitudinal rater training intervention in 2018-2019.

Trajectory Analysis of Health Care Utilization Before and After Major Surgery.

Objective: To characterize patterns of health care utilization before and after surgery and determine any association with preoperative frailty.

Background: Frail patients experience worse postoperative outcomes and increased costs during the surgical encounter. Evidence is comparatively lacking for the longer-term effects of frailty on postoperative health care utilization.

Preclerkship Medical Students' Use of Third-Party Learning Resources.

Importance: Undergraduate medical education increasingly relies on asynchronous, virtual learning; and medical educators have observed students engaging in self-directed learning outside of their institutional curriculum using widely available third-party resources. If medical educators better understand how students are learning, they may uncover novel opportunities to improve preclerkship education.

Objective: To explore how and why preclerkship medical students use third-party learning resources.

Perceptions of and Experiences with the COVID-19 Pandemic Among Individuals with Inflammatory Bowel Disease.

The COVID-19 pandemic resulted in increased feelings of emotional distress and disruptions in care across diverse patients subgroups, including those with chronic medical conditions such as inflammatory bowel diseases (IBD). We sought to understand the impact of the pandemic on the physical and emotional well-being of individuals with IBD and concurrent depression and/or anxiety symptoms. We conducted qualitative interviews after the beginning of the pandemic with 46 adults with IBD.

Learning enhances representations of taste-guided decisions in the mouse gustatory insular cortex.

Learning to discriminate overlapping gustatory stimuli that predict distinct outcomes - a feat known as discrimination learning - can mean the difference between ingesting a poison or a nutritive meal. Despite the obvious importance of this process, very little is known on the neural basis of taste discrimination learning. In other sensory modalities, this form of learning can be mediated by either sharpening of sensory representations, or enhanced ability of "decision-making" circuits to interpret sensory information.

Bias-corrected and doubly robust inference for the three-level longitudinal cluster-randomized trials with missing continuous outcomes and small number of clusters: Simulation study and application to a study for adults with serious mental illnesses.

Longitudinal cluster-randomized designs have been popular tools for comparative effective research in clinical trials. The methodologies for the three-level hierarchical design with longitudinal outcomes need to be better understood under more pragmatic settings; that is, with a small number of clusters, heterogeneous cluster sizes, and missing outcomes. Generalized estimating equations (GEEs) have been frequently used when the distribution of data and the correlation model are unknown.

Development of a student-created internal medicine frameworks website for healthcare trainees.

Objectives: Describe medical student perspectives on framework learning and develop a free, online, mobile-friendly framework website.

Methods: Internal medicine clerkship students were surveyed at a single U.S.

The Urgency of Now: Rethinking and Improving Assessment Practices in Medical Education Programs.

Assessment is essential to professional development. Assessment provides the information needed to give feedback, support coaching and the creation of individualized learning plans, inform progress decisions, determine appropriate supervision levels, and, most importantly, help ensure patients and families receive high-quality, safe care in the training environment. While the introduction of competency-based medical education has catalyzed advances in assessment, much work remains to be done.

Natural Language Processing of Learners' Evaluations of Attendings to Identify Professionalism Lapses.

Unprofessional faculty behaviors negatively impact the well-being of trainees yet are infrequently reported through established reporting systems. Manual review of narrative faculty evaluations provides an additional avenue for identifying unprofessional behavior but is time- and resource-intensive, and therefore of limited value for identifying and remediating faculty with professionalism concerns. Natural language processing (NLP) techniques may provide a mechanism for streamlining manual review processes to identify faculty professionalism lapses.

Faculty Perceptions of Frame of Reference Training to Improve Workplace-Based Assessment.

Background: Workplace-based assessment (WBA) is a key assessment strategy in competency-based medical education. However, its full potential has not been actualized secondary to concerns with reliability, validity, and accuracy. Frame of reference training (FORT), a rater training technique that helps assessors distinguish between learner performance levels, can improve the accuracy and reliability of WBA, but the effect size is variable.

Performance and Resilience Analysis of a New York Drinking Water System to Localized and System-Wide Emergencies.

Drinking water utilities are vulnerable to both human-caused and natural disasters that can impact the system infrastructure and the delivery of potable water to consumers. Analyzing system performance and resilience can help utilities identify areas of high risk or concern, understand the impacts on consumers, and evaluate response actions during disasters. In this case study, the Water Network Tool for Resilience (WNTR) was used to investigate the performance and resilience of a drinking water system in New York during increased demands due to firefighting, pipe damage, and loss of the source water emergencies.

Experience-dependent plasticity of gustatory insular cortex circuits and taste preferences.

Early experience with food influences taste preference in adulthood. How gustatory experience influences development of taste preferences and refinement of cortical circuits has not been investigated. Here, we exposed weanling mice to an array of taste solutions and determined the effects on the preference for sweet in adulthood.

Gender-Based Differences in Language Used by Students to Describe Their Noteworthy Characteristics in Medical Student Performance Evaluations.

Purpose: The noteworthy characteristic (NC) section of the medical student performance evaluation (MSPE) was introduced to facilitate holistic review of residency applications and mitigate biases. The student-written aspect of the characteristics, however, may introduce biases resulting from gender differences in self-promotion behaviors. The authors conducted an exploratory analysis of potential gender-based differences in language used in NCs.

Can Rater Training Improve the Quality and Accuracy of Workplace-Based Assessment Narrative Comments and Entrustment Ratings? A Randomized Controlled Trial.

Purpose: Prior research evaluating workplace-based assessment (WBA) rater training effectiveness has not measured improvement in narrative comment quality and accuracy, nor accuracy of prospective entrustment-supervision ratings. The purpose of this study was to determine whether rater training, using performance dimension and frame of reference training, could improve WBA narrative comment quality and accuracy. A secondary aim was to assess impact on entrustment rating accuracy.