bluuebunny/crossref_metadata_2025_split huggingface dataset:
Residency and Fellowship Program Administrator Burnout: Measuring Its Magnitude
Authors: Ewen Alana M. , Higgins Mikhail C.S.S. , Palma Sandra , Whitley Kathryn , Schneider Jeffrey I. 
Published: August 2019

ABSTRACT

Background
Little is known about the level of burnout among program administrators (PAs) working in graduate medical education.

Objective
We created a national database with baseline burnout data for PAs from residency and fellowship programs, including intention to leave their current positions.

Methods
A cross-sectional study was conducted in July 2017 to assess levels of burnout in a national cohort of PAs, who were largely members of online specialty forums. The Copenhagen Burnout Inventory (CBI) was used to measure burnout. Univariate analysis produced descriptive statistics for CBI. We performed a 2-sample t test to measure differences in average burnout scores for those who had thoughts of resigning from their positions and those who had not.

Results
Of the approximately 10 205 national PAs, we sampled 1126 (11%). Of the 1126 individuals who received the study information, 931 (83%) completed the baseline survey. Total mean scores for all subscales were elevated (personal: 53.7, SD 21.4; work-related: 52.0, SD 22; and client-related: 30.6, SD 20.8; each scale ranged from 0, low, to 100, high). Burnout scores differed between those contemplating leaving their jobs and those who were not, across all subscales of CBI, including personal (64.2 versus 42.4, –24.18 to –19.44 confidence interval [CI]), work-related (63.5 versus 39.7, –26.12 to –21.35 CI), and client-related (36.6 versus 24.2, –14.95 to –9.84 CI; P &lt; .0001 for all).

Conclusions
In this national survey of PAs, burnout scores measured by the CBI were higher among those who had considered leaving their positions.
An Electronic-Based Curriculum to Train Acute Care Providers in Rural Haiti and India
Authors: Khan Ayesha , Sebok-Syer Stefanie S. , Linstadt Hanna , Storm Megan , Modan Nadeem , Bosco Mukteshwari K. , Prashanth Gayathri , Mahadevan S.V. 
Published: August 2019

ABSTRACT

Background
Access to a trained, competent health care workforce remains a challenge globally, particularly in rural settings. To bridge this gap, the World Health Organization calls for innovations in electronic learning and task shifting. Yet, these approaches are underutilized due to cost, challenges associated with implementing technology, and a lack of suitably educated trainees.

Objective
We explored the feasibility of the Acute Care Providers Project (ACPP) to remotely train community members to be health care providers in 2 sites: Haiti and India.

Methods
The ACP program is an asynchronous curriculum that provides core health content and a structured approach to clinical care through an electronic curriculum. The curriculum is reinforced with case-based practice and hands-on workshops for procedural skills. ACPP was deployed in rural Haiti and India. Evaluation of the program included multiple-choice pretests and posttests, an objective structured clinical examination (OSCE), and direct observation of skills.

Results
Four Haitian and 55 Indian trainees completed the course. In Haiti, mean scores were 34.8% (SD 12.4) on the pretest and 78.0% (SD 6.5) on the posttest (P = .004). Trainees scored 100% on the OSCE and passed the skills checklist. In India, mean scores were 16.5% (SD 3.9) on the pretest and 81.7% (SD 9.0) on the posttest (P &lt; .001). Trainees scored a median of 91.8% (SD 3.95) on the OSCE and all passed the skills checklist.

Conclusions
The ACPP offers a scalable, replicable asynchronous curriculum to train lay individuals to provide basic health care in rural communities.
Assessing the Clinical Learning Environment in an Institution in the United Arab Emirates: The Resident Perspective
Authors: Kannan Indira , Jaiganesh Thiagarajan , Nair Satish Chandrasekhar , Alhammadi Yaaqoob , Nabi Bibi Fatima Ghulam , Alabdouli Amani Obaid Salem , Sheleh Hussein 
Published: August 2019

ABSTRACT

Background
A new accreditation model in the United States has increased focus on the clinical learning environment (CLE). There is limited research on trainee perceptions of the CLE in international settings.

Objective
We surveyed residents to obtain their perspective on the CLE at 1 sponsoring institution in the United Arab Emirates (UAE).

Methods
We surveyed residents at Tawam Hospital, UAE, a sponsoring institution with 142 trainees, on their perspectives in the 6 focal areas of the US Clinical Learning Environment Review (CLER) to gather baseline information. We administered a 26-item questionnaire to residents through an audience response system in November 2018.

Results
Of 100 residents in postgraduate year 2 and above, 72 (72%) responded. The perspective of the majority of respondents was favorable in the areas of reporting patient safety incidents, engaging in quality improvement activities, using a standardized form for care transition, and using professional guidelines for electronic health record documentation. In contrast, only half of the respondents perceived there is honesty in the reporting of duty hours, and only 36% felt the organization supported fatigue management. Other areas for improvement included residents' understanding of the concept of health disparities and activities to address health disparities.

Conclusions
Our findings suggest that in key focal areas related to patient safety, health care quality, care transitions, and professionalism, UAE residents have similar perceptions of their CLE as US trainees. Opportunities for improvement include duty hour reporting, fatigue mitigation, and addressing health disparities.
Contrasting Residency Training in Japan and the United States From Perspectives of Japanese Physicians Trained in Both Systems
Authors: Heist Brian S. , Torok Haruka Matsubara 
Published: August 2019

ABSTRACT

Background
International medical graduates (IMGs) have significant exposure to clinical training in their home country, which provides opportunity for international comparison of training experiences. One relevant IMG population is Japanese physicians who have completed some training before entering residency programs in the United States and desire to improve medical education in Japan.

Objective
We examined Japanese IMGs' perceptions of the respective attributes of residency in the United States and Japan.

Methods
Individual semistructured interviews were conducted with 33 purposively sampled Japanese IMGs who had completed training. We used exploratory thematic analysis, iterative data collection, and thematic analyses with constant comparison.

Results
Comments were organized into 3 categories: (1) attributes of US residency preferable to Japanese residency; (2) attributes of residency training with no clear preference for the US or Japanese systems; and (3) attributes of Japanese residency preferable to US residency. Within each category, we matched themes to residency program requirements or culture of medical training. Main themes include high regard for Accreditation Council for Graduate Medical Education (ACGME) Common Program Requirements, with emphasis on efficient achievement of clinical competency through graded responsibility, contrasted with preference expressed for a Japanese training culture of increased professional commitment facilitated by a lack of work hour limits and development of broad clinician skills, including bedside procedures and radiology interpretation.

Conclusions
Japanese training culture contrasts with a US model that is increasingly focused on work-life balance and associated compartmentalization of patient care. These findings enhance our understanding of the global medical education landscape and challenges to international standardization of training.
Group Assessment of Resident Performance: Valuable for Program Director Judgment?
Authors: Duitsman Marrigje E. , Slootweg Irene A. , van der Marel Imke C. , Kate-Booij Marianne ten , de Graaf Jacqueline , Fluit Cornelia , Jaarsma Debbie 
Published: August 2019

ABSTRACT

Background
Group discussion of resident performance is an emerging assessment approach in postgraduate medical education. However, groups do not necessarily make better decisions than individuals.

Objective
This study examined how group meetings concerning the assessment of residents take place, what information is shared during the meetings, and how this influences program directors' judgment of resident performance.

Methods
In 2017, the researchers observed 10 faculty group meetings where resident performance was discussed and interviewed the program directors within a month after the meetings. We used a thematic framework analysis to identify themes from the transcribed meetings and interviews.

Results
The information shared by group members during the meetings had 2 aims: (1) forming a judgment about the residents, and (2) faculty development. Most group members shared information without written notes, most discussions were not structured by the program director, the major focus of discussions was on residents with performance concerns, and there was a lack of a shared mental model of resident performance. The program directors who benefited most from the meetings were those who thought group members were engaged and summarized the information after every discussion.

Conclusions
Unstructured discussions and a lack of a shared mental model among group members impede effective information sharing about resident performance with a developmental approach. Structured discussions with an equal amount of discussion time for every resident and creating a shared mental model about the purpose of the discussions and the assessment approach could enhance use of a developmental approach to assessing resident performance.
Roles, Responsibilities, and Needs of Institutional GME Leaders: A Multinational Characterization of Designated Institutional Officials
Authors: Abdel-Razig Sawsan , Ibrahim Halah 
Published: August 2019

ABSTRACT

Background
Since 2012, several academic centers in the Middle East have attained accreditation by the Accreditation Council for Graduate Medical Education International (ACGME-I). An emerging group of GME leaders have assumed the role of designated institutional official (DIO), leading their institutions to accreditation. Despite these DIOs' key positions in driving GME reform, there is a lack of published studies on the roles, responsibilities, and needs of DIOs in international settings.

Objective
We examined the characteristics, roles, responsibilities, and needs of DIOs in the Middle East.

Methods
A questionnaire was electronically distributed from December 2018 to February 2019 to all current and former DIOs in ACGME-I accredited institutions in the Middle East.

Results
Of 16 surveys sent, 11 (69%) were returned. All DIOs were physicians; the majority were women less than 55 years of age, and assumed the role of DIO in the past decade. Most DIOs felt prepared for the position and well supported by their institution and their program directors. All reported having additional roles beyond the DIO position. Most identified the most challenging aspect of their role related to GME budgets, training for their responsibilities, sharing best practices and documents such as DIO job descriptions and other key documents, and DIO training.

Conclusions
ACGME-I accreditation is a critical driver of efforts to define the DIO role. DIOs in the Middle East share common perceptions, experiences, and needs. Further research should identify professional development needs in an increasingly diverse international worldwide DIO community.
Sea cliff at Kieler Ufer (Pleistocene stripes 11&amp;#8211;16) &amp;#8211; large-scale architecture and kinematics of the Jasmund Glacitectonic Complex
Authors: Gehrmann Anna , Meschede Martin , Hüneke Heiko , Pedersen Stig A. Schack 
Published: August 2019

Abstract. The Kieler Ufer cliff section is a structural key location in the late Weichselian thrust-dominated-to-fold–thrust-dominated glacitectonic complex of Jasmund. Restoration and balancing of geological cross sections from the eastern coast (southern sub-complex) enabled strain quantification and the illustration of stress orientation. The entire horizontal shortening of the Kieler Ufer section is 1280 m (51.6 %) at its minimum. The thrust faults generally inclined towards south indicate a local glacier push from the S/SSW, which fits well into the glacio-dynamic model suggested by Gehrmann and Harding (2018).
The M&amp;#252;ritzeum in Waren (M&amp;#252;ritz): natural history museum and modern nature discovery centre
Authors: Küster Mathias 
Published: August 2019

Abstract. The Müritzeum is a nature discovery centre and a
museum in the heart of the Mecklenburg Lake District. It is the first
natural history museum in Mecklenburg-Vorpommern, with natural history
collections that are over 150 years old, and are still growing today. The
collections contain about 290 000 specimens from the fields of botany,
zoology and geology. An extensive library and an archive are also part of the museum.
Collecting, preserving and researching natural history are our main spheres of activity. The
exhibition in the Müritzeum offers the visitor a comprehensive insight
into the development of the nature and landscape of northeastern Germany
and of Mecklenburg-Vorpommern and the Lake Müritz region in particular. The
largest aquarium for indigenous freshwater species in Germany enables
visitors to imagine themselves in the underwater world of the Mecklenburg
Lake District.
Tiefer See – a key site for lake sediment research in NE Germany
Authors: Brauer Achim , Schwab Markus J. , Brademann Brian , Pinkerneil Sylvia , Theuerkauf Martin 
Published: August 2019

Abstract. Tiefer See formed in a subglacial gully system at
the end of the last glaciation in the northeast German lowlands. The lake
has been selected as a focus site within the TERENO (Terrestrial
Environmental Observatory) NE German observatory because it forms annual
laminations (calcite varves) providing detailed information of past climate
and environmental changes. Our research integrates palaeolimnology and
limnology by combining high-resolution analyses of the sediment record with
a comprehensive monitoring of the lake and its sedimentation processes since
2012. This allows evaluation of the observed effects of ongoing climate change
in the context of the long-term history of the lake. The lacustrine sediment
profile comprises the last 13 000 years and is dated by a multiple dating
approach. The sedimentation is dominated by biochemical calcite formation
and algal blooms. Detrital material from the catchment forms only a minor
component even during times of increased human impact. Repeated changes
between well-varved, poorly varved and homogeneous sediment intervals
indicate that sedimentation processes in the lake are particularly sensitive
to changes in lake circulation. The research at Tiefer See is embedded
in ICLEA (https://www.iclea.de, last access: 2 August 2019) and BaltRap (https://www.io-warnemuende.de/projekt/167/baltrap.html, last access: 2 August 2019) projects.
Understanding Human Behaviour in Information Security Policy Compliance in a Malaysian Local Authority Organization
Authors: Sarmoen Norhayati , Khalid Haliyana , Abd Rasid Siti Zaleha , A L Baskaran Shathees , Basiruddin Rohaida 
Published: August 2019

The utilization of the Information and Communications Technology (ICT), such as the Internet and electronic mail (e-mail) has made communication nowadays easier, faster and has tremendously reduced the usage of paper. However, if the usage of internet is not properly managed, the possibility of confidential information leakage from the inside of the organization to other entities outside of the organization may occur. The impacts of this malicious activity are beyond the boundaries and cannot be controlled despite implementing various preventive steps and enforcing various regulations. Previous studies have outlined different factors in influencing information leakages in various organizations. However, none had really identified the severity of the factors up to this day. This research hopes to fill this gap, by focusing on staff in Majlis Perbandaran Pasir Gudang (MPPG), Johor, Malaysia. This study covers factors related to human behaviour which have led towards the cases of information breach. The factors include the lack of understanding of information policy, the lack of training, poor management support and the insensitivity of the staffs toward safeguarding the information from falling to the wrong hands. Thus, it is suggested that the ICT security protection needs to be robust, secure and reliable so that the use of the internet or social media will not only enhance the communication efficiency, but also to ensure that the information security in an organization is at the most optimum level.
Orthopaedic Residents' Transfer of Knee Arthroscopic Abilities from the Simulator to the Operating Room
Authors: Ledermann Gerardo , Rodrigo Andrés , Besa Pablo , Irarrázaval Sebastián 
Published: August 2019

Introduction:
The ultimate goal for any surgical simulation program is to prove the capability of transferring the skills learned to real-life surgical scenarios. We designed an arthroscopic partial meniscectomy (APM) training program and sought to determine its ability to transfer skills to real patients.

Methods:
Eleven junior orthopaedic residents and three expert knee surgeons were included. A low-fidelity knee simulator was used. Trainees had two baseline assessments of completing APM on a supervised real patient and on the simulator, measured using the Arthroscopic Surgical Skill Evaluation Tool (ASSET). After baseline, the trainees completed an APM training program and had a final evaluation of proficiency on the simulator and in real patients. Experts were also assessed for comparison. Statistical analysis was performed, assuming nonparametric behavior of variables.

Results:
All trainees improved from a base score of 14 points in real patients and 10 points on the simulator to a final score of 39 points and 36 points, respectively (P < 0.01). The final trainee simulator score did not differ from experts on the simulator and was lower in real patients (36 versus 39 points, respectively, P ≤ 0.01), which resulted in a 92% transfer ratio for the simulator.

Discussion:
Simulated training of APM in orthopaedic residents using a low-fidelity knee simulator proved to not only improve simulated proficiency but also successfully transfer skills to a real clinical scenario with a high model transfer ratio.

Level of Evidence:
Level II (Prospective Cohort Study)
Assessment of the factors influencing primary care physicians’ approach to vaccination of adult risk groups in Istanbul, Turkey
Authors: Yılmaz Karadağ Fatma , Sağlam Zuhal Aydan 
Published: August 2019

Background
We aimed to assess the factors influencing primary care physicians’ (PCPs) approach to adult vaccination in specific risk groups and evaluate the compliance to adult immunization guidelines.

Methods
This cross-sectional study performed between January 2016 and April 2016 in İstanbul, Turkey. A questionnaire designed to obtain physicians’ demographical data, experience, immunization status, and attitude on prescribing or recommending vaccines for adults in the risk group. Healthy individuals older than 65 and patients suffer from chronic diseases or had splenectomy before are considered as a risk group. The questionnaire was sent via email to a randomly selected group of 1,500 PCPs. The data of 221 physicians who responded emails were recorded for statistical analysis.

Results
Of the 221 participants (123 women, 98 men), the majority were aged 31–40 years. Their vaccination rates were 74.2% for hepatitis B, 54.3% for seasonal influenza, and 47.1% for tetanus. Among participants, the highest recommendation and prescription rate of adult vaccines was recorded in PCPs aged 31–40 years. In addition, PCPs with <10 years occupational experience were found to prescribe adult vaccines more frequently than PCPs with longer occupational experience.

Conclusions
Primary care physicians with lower age and relatively less experience are more intent to prescribe adult vaccines to patients that are in risk groups. This result may be due to increased awareness of adult immunization among PCPs who had more recent medical training. However, many other factors could have caused this difference, including physicians’ approach to primary medical care.
“r/Thritis”, Pregnancy, and Parenting: A Qualitative Descriptive Study of Reddit Forums to Explore Information Needs and Concerns of Women With Rheumatoid Arthritis
Authors: Chew Caitlin , Rebić Nevena , Baldwin Corisande , Amiri Neda , Proulx Laurie , De Vera Mary A. 
Published: August 2019

ObjectiveRheumatoid arthritis (RA) disproportionately affects more women than men, often striking during childbearing years. Because the Internet, particularly social media, is increasingly used by patients with chronic conditions seeking and sharing information, our objective was to conduct a qualitative descriptive study of threads on the social news website, Reddit, to understand the information needs and concerns of women with RA regarding pregnancy and parenting.MethodsWe searched threads (original posts and responses) on three subreddit sites, “r/Thritis,” “r/Rheumatoid,” and “r/BabyBumps,” over a 10‐year period between October 27, 2008, and October 27, 2018. All threads were reviewed, and those that specifically mentioned having RA and fertility/family planning, pregnancy/reproduction, and/or parenting/having children were included. We applied a thematic analysis to the threads, which involved initial line‐by‐line coding, clustering of codes into subcategories and categories, and abstraction into final themes.ResultsWe identified 87 threads and included 59 for qualitative analysis. The thematic analysis led to the identification of five themes. Theme one (finding a community) captures motivations for seeking information online. Themes two (making decisions about pregnancy and having children) and three (worrying about the impacts of arthritis on pregnancy and parenting) capture women's concerns and thought processes. Themes four (information needs for managing arthritis throughout the perinatal period) and five (pregnancy information and resources for women with arthritis) describe the community's specific informational needs.ConclusionA qualitative analysis of publicly available threads about the relationship between RA and issues of pregnancy and parenting identified areas of concern and further information need. These forums also provided an online community where women with RA sought social support and encouragement. Altogether, findings speak to the importance of supporting the information and care needs of women with RA who are pregnant or considering pregnancy.