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Factors Influencing Underrepresented Minority Applicants’ Ranking of General Surgery Residency Programs 影响少数族裔申请人对普通外科住院医师项目排名的因素
Pub Date : 2024-03-26 DOI: 10.3998/mjm.4814
Rita R. Shehiriana, Caroline E. Richburg, Maya J. Smith, Sonia S. Iyengar, Jessica R. Santos-Parker, Grace F. Chao, G. Kwakye
Background: Underrepresented minorities (URM) are disproportionately lacking in academic surgery, yet there is wide variation in URM in residency programs. This mixed methods study aims to describe factors that URM interns identified as important in their rank list of general surgery residency programs. These data will aid institutions in increasing URM representation and creating supportive training environments in academic surgery.Methods: We employed a mixed methods approach using an online survey and semi-structured interviews developed through focus group engagement and literature review. Interviews were audio recorded, transcribed, and coded for themes. We conducted narrative thematic analysis.Results: Sixty-four incoming general surgery interns completed the survey with median age 25 to 29. Of respondents, 67% identified as female and 34% as URM. URM general surgery interns were more likely to rate program benefits and finances, revisit opportunities (ie, organized post-interview revisit weekends), and post-graduate job opportunities higher than were non-URM participants (p<0.05). URM participants also ranked factors such as diversity of residents and faculty and diversity and inclusion statements by programs higher than did non-URM participants (p<0.05). Five URM interns completed semi-structured interviews. Qualitative themes influencing URM interns’ rank list decisions included (1) presence of URM in the program, (2) program support of resident-led goals, (3) active inclusivity initiatives, and (4) direct experiences of current URM residents. All interview participants relied heavily on interactions with current URM residents as a source of information. Detractors from programs included interns concerned with being the only person of color at their prospective program and no concrete initiatives or goals in place to support diversity and inclusion, raising concern for performative allyship.Conclusions: When evaluating residency programs, URM weighed current representation and support of URMs, active diversity and inclusion initiatives within a program, and lived experiences of URM residents. Surgery residency programs should take steps to not only intentionally recruit URM applicants but also create a supportive training environment that is diverse, inclusive, and empowering.
背景:在外科学术领域,少数族裔代表人数不足(URM)的情况尤为严重,但在住院医师培训项目中,少数族裔代表人数的差异却很大。这项混合方法研究旨在描述少数民族实习生在普外科住院医师培训项目排名中认为重要的因素。这些数据将有助于相关机构增加统招实习生的比例,并在外科学术领域创造有利的培训环境:我们采用了一种混合方法,即在线调查和通过焦点小组参与和文献回顾制定的半结构化访谈。我们对访谈进行了录音、转录和主题编码。我们进行了叙事主题分析:64名新入职的普外科实习生完成了调查,年龄中位数为25至29岁。67%的受访者认为自己是女性,34%认为自己是乌拉圭人。与非统招实习生相比,统招普外科实习生对项目福利和财务、重访机会(即面试后有组织的周末重访)以及毕业后工作机会的评价更高(P<0.05)。对住院医师和教师的多样性以及项目的多样性和包容性声明等因素的排名,URM 参与者也高于非URM 参与者(P<0.05)。五名统招实习生完成了半结构化访谈。影响URM实习生排名表决定的定性主题包括:(1)项目中是否有URM;(2)项目对住院医师主导目标的支持;(3)积极的包容性举措;(4)当前URM住院医师的直接经验。所有参加访谈的人都非常依赖于与现任住校生的交流作为信息来源。对项目不满意的人包括实习生,他们担心自己是未来项目中唯一的有色人种,也没有支持多样性和包容性的具体措施或目标,这引起了对表演性盟友关系的担忧:在评估住院医师培训项目时,URM 会权衡目前URM 的代表性和支持情况、项目内积极的多样性和包容性举措以及URM 住院医师的生活经历。外科住院医师培训项目应采取措施,不仅要有意识地招收统招住院医师,还要创造一个支持性的培训环境,使其具有多样性、包容性和赋权性。
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引用次数: 0
A Peristaltic Pump to Improve Bladder Emptying and Irrigation in Patients Who Use Clean Intermittent Catheterization 蠕动泵可改善使用清洁间歇导尿术患者的膀胱排空和冲洗效果
Pub Date : 2024-03-26 DOI: 10.3998/mjm.4816
Arjun Rajan, Jason W. Lo, Likitha Nimmagadda, Emily R. Bozich, Jason Qu, Julian Wan, B. Sack
Background: Neurogenic bladder patients who intermittently catheterize may have systems that drain slowly and incompletely. These limitations can lead to urinary tract infections and bladder stone formation and be time consuming. We hypothesize that a catheter accessory device could improve drainage, reduce residual bladder volume, and save time.Methods: A yearlong collaboration between an undergraduate biomedical engineering student design team and client mentors from the pediatric urology department led to an evaluation of solutions to enhance emptying of bladders that require intermittent catheterization. Students performed market analysis, identified design requirements, generated design concepts, conducted usability testing, and constructed alpha and beta prototypes verified through benchtop experimentation during the yearlong project. Prototypes were verified using a phantom bladder model built from a compliant stress ball with an attached catheter and placed under an external pressure of 5 cm H 2 O. Tests were conducted to measure the diff erence between passive drainage and device-assisted drainage at various bladder volumes and catheter sizes. Eight student peers compared passive emptying, irrigating, and aspirating a phantom bladder model using the prototype or syringe to assess the usability of the device.Results: We developed a pump that interfaces with commercially available catheters. The pump housing was designed and 3D printed. Fluid can be moved bi-directionally with a battery-powered peristaltic pump and microcontroller. The pump has a built-in current sensing threshold with an automatic shutoff safety mechanism. Testing results showed that for all bladder volumes and catheter sizes, the pump emptied more completely and drained between 1.6 and 6.3 times faster when compared to passive drainage. Usability feedback showed that the pump required less time to irrigate the bladder and was preferred when compared to the manual syringe technique.Conclusions: This portable catheter pump improves phantom bladder emptying by increasing flow rate, decreasing residual volume, and making irrigation easier. Future design improvements will work to implement safety mechanisms and miniaturize the pump. This project demonstrates the feasibility of a catheter accessory device to improve patient quality of life and the ability for understudied clinical problems to be addressed through collaborations between capstone engineering design teams and physicians.
背景:间歇性导尿的神经源性膀胱患者可能会有排尿缓慢和不完全的系统。这些限制可能导致尿路感染和膀胱结石的形成,而且耗费时间。我们假设导尿管附属装置可以改善引流,减少膀胱残余容量,并节省时间:方法:一个生物医学工程本科生设计团队与来自儿科泌尿科的客户导师进行了为期一年的合作,评估了加强需要间歇性导尿的膀胱排空的解决方案。在为期一年的项目中,学生们进行了市场分析,确定了设计要求,提出了设计概念,进行了可用性测试,并构建了通过台式实验验证的 alpha 和 beta 原型。原型验证使用了一个由附有导管的顺应性压力球制成的膀胱模型,并将其置于 5 cm H 2 O 的外部压力下。在不同的膀胱容量和导管尺寸下,测试了被动排空和设备辅助排空之间的差异。八名学生同行比较了使用原型或注射器进行被动排空、灌注和抽吸模型膀胱的情况,以评估设备的可用性:结果:我们开发了一种可与市售导管连接的泵。我们设计并三维打印了泵的外壳。液体可通过电池供电的蠕动泵和微控制器双向流动。该泵具有内置电流感应阈值和自动关闭安全机制。测试结果表明,在所有膀胱容量和导管尺寸下,泵的排空更彻底,排空速度是被动排水的 1.6 到 6.3 倍。可用性反馈显示,泵灌洗膀胱所需的时间更短,与手动注射器技术相比更受欢迎:这款便携式导管泵通过提高流速、减少残余容量和简化灌注操作,改善了假想膀胱的排空效果。未来的设计改进将致力于实现安全机制和泵的小型化。该项目证明了导管附件设备改善患者生活质量的可行性,以及通过毕业设计工程设计团队和医生之间的合作来解决未得到充分研究的临床问题的能力。
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引用次数: 0
Introducing Mindfulness Practices to the Healer’s Art Course for Medical Students: A Feasibility Study 在医学生的 "医者之术 "课程中引入正念练习:可行性研究
Pub Date : 2024-03-26 DOI: 10.3998/mjm.4815
Kirin Saint, MD † C. Kenzie Corbin, M. M. ‡. Michael F. Barton, M. M. §. Julie Barrett, MD Heather L. Burrows
Introduction: Burnout is common among medical students in the United States and can be debilitating. Mindfulness practices can reduce stress levels and burnout. Integrating mindfulness practices into pre-existing medical courses such as the Healer’s Art can potentially reduce burnout.Methods: We evaluated the impact of introducing meditation and yoga into the Healer’s Art course at a midwestern medical school. Half of the students were randomized into a meditation class (n=11) and the other half were randomized into a yoga class (n=12). Students were given pre- and post- session surveys to assess measures of mindfulness, burnout, and energy levels, adapted from validated survey instruments. Paired two-sample t tests were used to assess the relationship between each intervention and each pre-specified outcome.Results: Twenty-three medical students participated in a one-time yoga or meditation session. The yoga intervention resulted in a statistically significant increase in energy and breath awareness outcomes. The meditation intervention resulted in a significant increase in mindfulness. Both yoga and meditation were found to decrease burnout among participants in the immediate aftermath. Ninety-six percent of participants (22 of 23) expressed that mindfulness practices should be incorporated into future the Healer’s Art courses, with a mean recommendation score of 4.5 out of 5.Conclusion: Yoga and meditation classes might reduce medical student burnout. Randomized control trials are needed to assess longevity and generalizability of findings.
导言:职业倦怠在美国医学生中很常见,而且可能会使人崩溃。正念练习可以降低压力水平和职业倦怠。将正念练习融入已有的医学课程(如 "医者之术"),有可能减轻倦怠感:我们评估了将冥想和瑜伽引入中西部医学院 "医者之术 "课程的影响。一半学生被随机分配到冥想课(人数=11),另一半学生被随机分配到瑜伽课(人数=12)。学生们接受了课前和课后调查,以评估正念、职业倦怠和能量水平,这些指标均改编自经过验证的调查工具。采用配对双样本 t 检验来评估每种干预措施与每种预设结果之间的关系:23名医学生参加了一次性瑜伽或冥想课程。瑜伽干预使能量和呼吸意识结果有显著的统计学增长。冥想干预则显著提高了正念。研究发现,瑜伽和冥想都能减少参与者在事件发生后的倦怠感。96%的参与者(23 人中有 22 人)表示,应将正念练习纳入今后的 "医者之术 "课程,平均推荐分数为 4.5 分(满分 5 分):结论:瑜伽和冥想课程可以减轻医学生的职业倦怠。需要进行随机对照试验,以评估研究结果的持久性和普遍性。
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引用次数: 0
A Missed Opportunity to Engage Students During a Crisis 错失危机中吸引学生参与的良机
Pub Date : 2024-03-26 DOI: 10.3998/mjm.4813
S. Irani, Samuel Klein, K. Gondy, M. Waselewski, Tammy Chang
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引用次数: 0
Tale of Two Journeys 两个旅程的故事
Pub Date : 2024-03-26 DOI: 10.3998/mjm.4812
K. Strubchevska, Marko Kozyk
Given the ongoing war in Ukraine, we hope our personal story will appeal to people. Our article aims to help readers understand the challenges medical professionals face coming to the United States. We escaped the horrors of the war and lost everything we had, except our hope. This year, only 10 Ukrainian physicians were selected as medical residents in US medical training programs, and we are honored to be two of them.
鉴于乌克兰的战争仍在继续,我们希望我们的个人故事能够吸引人们。我们的文章旨在帮助读者了解医疗专业人员来到美国所面临的挑战。我们逃离了恐怖的战争,失去了一切,唯有希望。今年,只有 10 名乌克兰医生被选拔为美国医学培训项目的住院医生,我们很荣幸成为其中的两名。
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引用次数: 0
A Student’s Perspective: Medical Education on Caring for Patients of All Abilities 学生的视角:照顾各种能力病人的医学教育
Pub Date : 2024-03-26 DOI: 10.3998/mjm.4817
Maxwell Sievers, Bryan Aaron, Kate Panzer, Rachel Gottlieb
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引用次数: 0
Doula-Supported Births and Outcomes Among DONA International Doulas, 2000-2012 2000-2012 年 DONA 国际助产士支持的分娩和结果
Pub Date : 2024-03-26 DOI: 10.3998/mjm.4819
Nicole E. Trupiano, Kea Turner, Stacey L Klaman
Introduction: Doula care has been shown to decrease maternal morbidity and mortality given the physical, emotional, and informational support that doulas provide during pregnancy and birth. Although usage of doulas and coverage of doula services have been increasing, several people are still unaware of the benefits doulas provide. In this study, we sought to describe characteristics related to doulas and doula-supported women on a national scale, including location, method of referral, childbirth settings and providers, and obstetric outcomes.Methods: We examined doula-supported births by year, state, urban/rural location, maternal age, and characteristics related to doulas, doula-supported birthing women, childbirth settings, providers, and obstetric outcomes. The sample population consisted of doula-assisted births (n=12,675) from 2000 to 2012 based on records from Doulas of North America (DONA) International. We used t tests or Pearson’s chi-squared test (X2) for continuous and categorical variables.Results: Doulas reported that the vast majority (73.2%) of all doula-supported women birthed by spontaneous vaginal birth and fewer than 1 in 5 (18.2%) women birthed by unplanned cesarean. Nearly 3 out of 4 (73.2%) women had some form of childbirth preparation instruction. Information regarding the source of referrals to doulas suggests that over half (52.9%) of birthing women found a DONA-member doula from a source other than a hospital system or DONA International. About half (49.7%) of birthing women supported by doulas were self-pay clients. Overall, few doulas (1.3%) received third-party reimbursements for their paraprofessional services. The vast majority (95.3%) of doula-supported births in the sample occurred in urban areas of the United States.Conclusions: This is the largest analysis of doula-supported births from the largest US doula certifying organization, which is critical for understanding how widespread access to doula services has the potential to significantly improve health outcomes for women and their infants during birth. Additionally, the data suggest there is a need for increased referrals and increased insurance coverage and potentially a heightened need for doula services in rural areas.
导言:鉴于朵拉在怀孕和分娩期间提供的身体、情感和信息支持,朵拉护理已被证明可降低孕产妇发病率和死亡率。尽管朵拉的使用率和朵拉服务的覆盖率都在不断增加,但仍有很多人不了解朵拉提供的益处。在这项研究中,我们试图在全国范围内描述与朵拉和朵拉支持的妇女有关的特征,包括地点、转诊方法、分娩环境和提供者以及产科结果:我们按照年份、州、城市/农村地区、产妇年龄以及与朵拉相关的特征、朵拉支持的分娩妇女、分娩环境、提供者和产科结果对朵拉支持的分娩进行了研究。根据北美朵拉国际组织(DONA)的记录,样本人群包括 2000 年至 2012 年期间由朵拉协助的分娩(n=12,675)。我们对连续变量和分类变量采用t检验或皮尔逊卡方检验(X2):结果:据Doulas报告,绝大多数(73.2%)由Doulas支持的产妇是通过阴道自然分娩的,只有不到五分之一(18.2%)的产妇是通过意外剖宫产分娩的。近四分之三(73.2%)的妇女接受过某种形式的分娩准备指导。有关朵拉转介来源的信息表明,半数以上(52.9%)的分娩妇女是从医院系统或DONA国际组织以外的来源找到DONA成员朵拉的。在得到朵拉支持的分娩妇女中,约有一半(49.7%)是自费客户。总体而言,很少有朵拉(1.3%)因其辅助专业服务而获得第三方补偿。样本中绝大多数(95.3%)由朵拉支持的分娩发生在美国城市地区:这是美国最大的朵拉认证组织对朵拉支持下的分娩进行的最大规模的分析,这对于了解朵拉服务的普及如何有可能显著改善妇女及其婴儿在分娩过程中的健康状况至关重要。此外,数据还表明,有必要增加转诊、提高保险覆盖率,并有可能提高农村地区对朵拉(doula)服务的需求。
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引用次数: 0
Survey of Medical Student Debt Status, Financial Literacy, and Desires for Financial Education 医学生债务状况、金融知识和金融教育愿望调查
Pub Date : 2024-03-26 DOI: 10.3998/mjm.4818
Anderson Lee, Jamaal K Tarpeh, Emma C Manuel, Kristian M Black, B. McMichael, Jesse Wilson, Niki Matsuko, M. J. Englesbe, Brian Fallon, Gurjit Sandhu
Objectives: The purpose of this study was to assess the financial literacy level of medical students, evaluate their perceptions about the importance of financial literacy, and determine the optimal timing and delivery for financial literacy education.Methods: From April to May 2019, a cross-sectional, anonymous, web-based survey was administered to a convenience sample of first-year (M1) to fourth-year (M4) medical students at the University of Michigan Medical School, with 216 of 680 (32%) students completing the survey. Respondents voluntarily answered 15 multiple choice questions on personal finance and 30 questions on their demographics, current financial situation, and opinions on financial literacy education. Individual financial proficiency was defined as answering 60% of the personal finance questions correctly.Results: Overall, respondents correctly answered 5.64 (38%) of the personal finance questions, with 41 (19%) students achieving financial proficiency. Lower performance on the financial literacy assessment was significantly associated with gender, age, and debt. Overall, 192 (89%) medical students believed that they should receive financial literacy training in medical school.Conclusions: Medical students demonstrate low levels of financial literacy and have a strong desire to improve their financial literacy during their medical education. Medical schools are well positioned to harness this interest for financial literacy education and integrate self-directed learning opportunities.
研究目的本研究旨在评估医学生的金融知识水平,评价他们对金融知识重要性的看法,并确定金融知识教育的最佳时间和方式:2019年4月至5月,密歇根大学医学院对一年级(M1)至四年级(M4)的医学生进行了一次横断面匿名网络调查,680名学生中有216人(32%)完成了调查。受访者自愿回答了 15 道有关个人理财的多项选择题和 30 道有关其人口统计学、当前财务状况以及对理财知识教育的看法的问题。个人理财能力的定义是正确回答 60% 的个人理财问题:总体而言,受访者正确回答了 5.64 个(38%)个人理财问题,其中 41 名(19%)学生达到了理财水平。财务知识评估成绩较差与性别、年龄和债务有明显关系。总体而言,192 名(89%)医学生认为他们应该在医学院接受财务知识培训:结论:医学生的金融知识水平较低,他们强烈希望在医学教育期间提高自己的金融知识水平。医学院完全有能力利用这种兴趣开展金融知识教育,并整合自主学习的机会。
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引用次数: 0
Leo Marker Leo Marker
Pub Date : 2024-01-10 DOI: 10.3998/wsfh.5361
Emily Marker
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引用次数: 0
Letter from the President of the Western Society for French History 西方法国历史学会主席的信
Pub Date : 2024-01-10 DOI: 10.3998/wsfh.5363
Andrew Ross
{"title":"Letter from the President of the Western Society for French History","authors":"Andrew Ross","doi":"10.3998/wsfh.5363","DOIUrl":"https://doi.org/10.3998/wsfh.5363","url":null,"abstract":"","PeriodicalId":516820,"journal":{"name":"2023","volume":" 47","pages":""},"PeriodicalIF":0.0,"publicationDate":"2024-01-10","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"139640375","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
引用次数: 0
期刊
2023
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