United States

Background: Female representation in medicine has surged in recent years, yet balancing career aspirations with family planning remains a formidable challenge. Understanding how fertility planning influences career decisions among medical professionals, particularly female physicians, is crucial for optimizing workforce dynamics and individual well-being.

Objective: This study aimed to assess the impact of fertility planning on career choices among medical professionals, identifying influencing factors such as specialization, practice setting, and work-life balance.

Methods: A survey was administered to residents and fellow physicians across various specialties at Cedars-Sinai Medical Center. Data on demographic characteristics, career status, childbearing considerations, workplace support, infertility diagnosis, and fertility preservation exploration were collected and analyzed.

Results: Among the 91 participants, a majority were female (62.6%), with diverse racial backgrounds. Family planning significantly influenced career trajectories, leading to extended career breaks (23.1%), delays in fellowship (18.7%), and specialty switches (14.3%). Participants indicated a median ideal of 2 children. Among the 12 individuals who had children, the median age for their first child was 31.5 years. A significant proportion anticipated or experienced the need to delay childbearing due to career considerations (75.4% and 66.7%, respectively). Dissatisfaction with workplace support for family planning was prevalent (79.1%), despite high interest in fertility benefits (92.6%).

Conclusion: Fertility planning exerts a profound influence on the career decisions and well-being of medical professionals, particularly female doctors. Addressing workplace support gaps and implementing supportive policies are imperative to mitigate the negative impact of fertility-related challenges on career trajectories and individual well-being.

AMA Research Challenge 2024 

Family Planning and Career Trajectories in Medicine

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Abstract Title: 
Identifying Creator Goals and Takeaways from an Antiracism Medical Education Podcast 

Background
The Clinical Problem Solvers Antiracism in Medicine (CPSolvers ARM) Podcast series was created in 2020 to equip listeners at all training levels with the consciousness and tools to practice antiracism in their clinical careers. Compared to other forms of information sharing within academia like conferences and journal publications, podcasting is accessible, entertaining, and allows for an increased degree of nuance. The ideation, planning, and question development for each episode is extensive and involves numerous group discussions as well as a deep dive into relevant peer-reviewed literature and lay press discourse. The goal of this research is to ascertain and clarify the takeaways, intentions, and goals of the podcast from the perspective of its creators. 

Methods
A focus group was conducted with the podcast’s creators. Creators are defined as individuals who have hosted and designed/led at least one CPSolvers ARM Series episode. Participants were recruited via email and were sent a waiver of documentation of consent. The focus group was conducted over zoom with a moderator. In the focus group, participants were asked about the goal of the podcast, their motivators for joining the team, things they have learned from working on the podcast, and what they hope listeners take away from the podcast. The interview audio transcript was then deidentified and extracted for themes by two different reviewers using Dedoose. The reviewers then consolidated their codes with associated representative quotes to generate a joint codebook and to determine overarching themes. 

Results
A total of four out of the eight eligible active podcast creators were present for the focus group. Four key themes were extracted with associated representative quotes. The themes include: Democratizing Antiracism Knowledge, Generative Paradigmatic Shifts in Antiracism Education, Novel Coalition and Community Building, and Theory to Praxis. 

Conclusion
The key themes extracted from the focus group suggest that from the creator’s perspective, key goals of the CPSolvers ARM podcast include making well-researched knowledge about antiracism in medicine more accessible to health care professionals, pushing medical education to include topics of antiracism and health equity more systemically and rigorously in learner curriculums, and encouraging education that stimulates learners towards action. Additionally, creators highlight the community and coalition-building aspect of the podcast as a major personal benefit. This provides insight into the thought process behind an antiracism medical education podcast and highlights the benefits of such a project to both creators and listeners alike.


Identifying Creator Goals and Takeaways from an Antiracism Medical Education Podcast

Background: India has significantly improved Infant mortality since its independence, reducing it from 146 per 1,000 live births in 1950 to 20 per 1000 live births in 2020. Despite this, India continues to face a critical shortage of neonatologists and neonatal intensive care resources, contributing to persistent challenges in reducing neonatal mortality rates. 
Methods: Data from the National Medical Commission (N.M.C.), the National Board of Examinations in Medical Sciences (NBEMS), and the government of India were analyzed to quantify the supply of neonatologists and neonatal intensive care seats across India. Data from the Royal College of Pediatrics and Child Health, Bliss for premature/sick babies, and the National Resident Matching Program were also examined for international comparisons. 
Results: India currently offers 138 seats in Neonatology, mainly 103 Doctorate of Medicine (D.M.) and 36 Diplomate of National Board (DrNB) seats, catering to approximately 24 million annual births. This leads to a ratio of 5.75 seats per million newborns, significantly lower than the optimal ratio observed in developed nations like the United States, which offers 84.7 seats per million newborns. Substantial inter-state variations were also observed. 
Conclusion: Extending the grandfather clause for pediatric professors by an additional decade would lead to increased neonatologists currently while mandating the establishment of neonatology departments as the fourth unit in medical colleges with at least 200 or 250 MBBS seats could potentially increase the number of neonatology seats to 390, substantially improving the neonatologist-to-neonate ratio to 16.25 per million newborns.


India's Neonatal Care Landscape: Workforce Challenges, N.M.C. Guidelines, Solutions, and State Government's Role in a Low-Resource Country

Implicit bias happens automatically and without intention. Nevertheless, these thoughts affect a person’s judgements, considerations, and behaviors. It is well-demonstrated in the literature that physicians experience implicit bias toward their patients, which in turn contributes to health inequities. However, there is little research conducted on patients’ implicit bias towards their physicians. Previous studies report no statistical difference in patient satisfaction when controlled for physician gender, despite evidence from opposing studies that identify female physicians as establishing more patient-centered care. This spurs a clinically relevant discussion surrounding bias in patients’ evaluations. There are limitations in collecting this data, as patients must be in a controlled environment, yet unaware of the research being conducted. As a result, Objective Structured Clinical Examinations (OSCEs), in which medical students are graded and receive feedback from Standardized Patients (SPs), lend an ideal environment to study patient implicit bias. Our study examines the implicit bias of SPs toward their student doctors based on gender during OSCEs. Data from Kansas College of Osteopathic Medicine’s SP student doctor evaluations, obtained in OSCEs, was acquired and de-identified. Consent from SPs to conduct this research was obtained, yielding 576 comments for 90 first-year medical students across 8 OSCEs. A direct content analysis was performed on these comments. Guided by prior literature surrounding patients’ perception of physicians, feedback was coded into five categories: compassion, demeanor, communication, comfort delivery, and physical appearance. Within each category, feedback was further coded by male or female student doctor gender and positive or negative feedback sentiment. A chi-squared test for independence was performed on data in each category to explore the hypothesis: 

H0: There is no association between medical student gender and simulated patient feedback sentiment. 

HA: There is a significant association between female gender and positive feedback sentiment. 

Results displayed a significant association between female student gender and positive SP feedback regarding compassion (p = 0.017), as well as a significant association between female student gender and negative SP feedback regarding physical appearance (p = 0.038). There was no significant association found between medical student gender and SP feedback regarding student demeanor, communication, or comfort delivery. These findings aid understanding of how physicians’ genders correlate with patients’ perceptions of them, and which characteristics in a clinical encounter can be leveraged to significantly impact this impression.

Simulated Patient Implicit Bias of Medical Student Gender

Background: Studies have shown that the absence of skin color representation in health science education leads to diminished patient outcomes for these populations. As awareness of this issue grows, literature has emerged to analyze these discrepancies. Expanding teaching images to include a diverse range of all skin types is crucial for promoting equal representation in education. 
Objective: This study aims to assess skin color representation in pediatric nursing practitioner (PNP) education through a systematic analysis of eight commonly used nursing textbooks. 
Methods: Eight commonly referenced nursing textbooks were analyzed, given their established use in PNP education. Textbooks were coded for skin color representation by two investigators trained in skin phototyping. Coders used the widely accepted phototyping scale, the Fitzpatrick Scale (range I-VI). Teaching photographs were defined as all photos, including human skin, that provided insight into a disease, diagnostic technique, or concept. Two individual coders coded and documented data, ensuring each coder was blinded to the overall results. 
Results: Textbooks were included based on the presence of teaching images involving human skin that were not black and white. Of the eight textbooks selected, five were considered given these criteria. A significant proportion of chapters demonstrated skin color underrepresentation. However, chapters addressing conditions of abuse, neglect, and stigmatized social issues displayed a disproportionate representation of skin of color. 
Conclusion: These findings highlight the importance of enhancing equitable representation in nursing educational resources while collaborating with health science institutions to establish clear, standardized metrics for future implementation. Including skin tone diversity in health science education materials is necessary to ensure clinicians have the knowledge and training to provide all patients with the highest level of care.



Skin of Color Representation in Teaching Images in Pediatric Nursing Practitioner Textbooks

Background: Repeated large-scale studies have reinforced our understanding of smoking as the likely single most important modifiable risk factor affecting health and longevity. Although medical students receive instruction on how to navigate lifestyle change conversations with patients, specific education on how to perform smoking cessation counseling may be very minimal in the pre-clinical years. While the rates of smoking within the general US population have dropped to around 12% as of 2021, individuals undergoing substance use disorder treatment have rates of smoking as high as 80%. As New Orleans Bridge House (NOBH) works with individuals undergoing rehabilitation from substance use disorder, volunteers should be equipped to engage in smoking cessation discussions on every shift. Our analysis evaluates the efficacy of implementing a 15-minute pre-shift training on smoking cessation counseling for all medical student volunteers. 

Methods: The smoking cessation volunteer training takes place in the 15 minutes preceding the volunteer's shift. The on-shift leader first facilitates an open discussion on smoking cessation between all volunteers to gauge the level of knowledge and experience with the content. Focus areas are divided into cessation aids (ex., specific medications) and conversational techniques (ex. motivational interviewing). Next, an info sheet from NY.gov contains details about all FDA-approved pharmaceutical interventions for smoking cessation. The leader then guides all volunteers through a review of the information, ensuring to answer all volunteer questions. 4th year student volunteers were encouraged to provide advice based on their experiences in clinic rotations. 1st-year students are then encouraged to complete a 5-question electronic survey emailed one and three days after their volunteer shift. 

Results: Between 8/16/2023-9/27/2024, 45 responses were received from approximately 106 volunteers, yielding a response rate of 42%. 64% of students reported discussing smoking cessation with a patient during their shift. In response to whether the pre-shift discussion helped their ability to address this topic with patients, 62% answered “definitely yes,” and 26% answered “somewhat yes,” with no students reporting that the session was unhelpful. Out of the list of cessation aids discussed during the training, the three that students were least aware of were nicotine nasal spray (64% unaware), combination nicotine replacement therapy (45%), and nicotine lozenges (42%). 

Conclusion: The majority of medical student volunteers at NOBH engage in smoking cessation discussion with a patient during each shift. Nearly every surveyed volunteer believed they benefited from brief pre-shift training and the majority learned about at least one new cessation aid. Further investigation is needed to evaluate patients’ perceptions of these conversations and outcomes with regards to long term smoking cessation.

Smoking Cessation Counseling: 15-Minutes to Learn, A Lifetime to Master

Background
Bias incidents in health care harm everyone involved: clinicians, trainees, interdisciplinary team members, and patients. Clinicians who experience in-the-moment bias-related incidents from patients and their families endure professional and emotional repercussions. Previously published curricula addressed bias using didactics and small group discussions as teaching methods. Our communication course tackles the need to teach trainees how to respond to in-the-moment patient/family explicit bias-related incidents towards clinicians. Our course utilizes real-time simulation practice in culturally sensitive topics with communication skills to approach and address bias-related incidents.
Methods
We trained 13 Hospice and Palliative Care Medicine (HPM) fellows from three institutions. We created a two-hour-long virtual course divided into three parts: a brief didactic lecture, faculty demonstration of skills, and real-time learner practice with simulated patients. The skills taught included acknowledging the incident, challenging biased beliefs, naming common interests, and setting limits. Participants completed pre-course, and post-course surveys (immediate and two months).
Results
In the pre-course survey, all participants (13) expressed concerns about responding when a patient or family member says something biased. In the immediate post-survey, 100% (8/8) of respondents agreed that training is crucial. 87% (7/8) of participants reported increased self-confidence in addressing bias incidents based on skills developed in the course. Two months later, two participants reported using the skills learned at the communication course to address a bias-related incident.
Conclusion
The course improved the fellows' self-perceived ability and confidence in responding to bias-related incidents. After the training, the fellows applied skills learned in clinical settings.

The Patient Said What?!? Now, what do I say? – How to Address in-the-moment Patient/Family Explicit Bias Towards Clinical Team Members.

Background
Penicillin is the most common drug allergy. While up to 20% of the population may acquire the penicillin allergy label in their lifetime, more than 90% can safely receive it, leading to unnecessary use of higher order antibiotics The PEN-FAST tool is a validated clinical decision rule used to identify low-risk penicillin allergies. By teaching antibiotic stewardship and use of this tool, we can promote better patient and public health outcomes. 

Methods
A 1-hour teaching module on penicillin allergy and antibiotic stewardship was given as a new curriculum during a fourth-year undergraduate medical education capstone course (N=136). Survey data was collected using Qualtrics and analyses performed in Excel. Pre- and post-surveys were linked using unique codes without any identifying information.

Results
Data collection included both qualitative and quantitative measures, including 5-point Likert scales and multiple-choice questions. There was a statistically significant increase (p<0.05) in student-reported comfort with recognizing anaphylaxis and using the PEN-FAST tool in clinical settings, familiarity with the PEN-FAST tool and antibiotic stewardship, and level of understanding of the process of penicillin allergy de-labeling. There was also significant improvement in performance on calculating PEN-FAST score and identifying next steps in penicillin allergy de-labeling (from 31.2% and 39.0% correct to 66.7% and 59.3% correct, respectively).

Conclusion
While our sample size was small, we implemented effective teaching of both antibiotic stewardship and PEN-FAST clinical tool use. Students self-reported increased comfort and familiarity and demonstrated knowledge application on quantitative assessment. The results suggest that this teaching module successfully met its learning objectives and future work will consist of building on this content and extending dissemination.

Penicillin Allergy and Antibiotic Stewardship: Training Medical Students to Apply the PEN-FAST Tool 


Background
Virtual Reality (VR) technology is a valuable tool for teaching procedural skills. VR allows students to develop skills in a realistic but controlled setting, and as a self-contained teaching module, could reduce instructor burden. Many researchers have explored the use of VR in educational environments and demonstrated that VR training may be comparable to traditional in-person instruction. The goal of this study was to demonstrate the feasibility of using VR technology to teach central venous catheter (CVC) insertion to medical students.

Methods
Ten fourth-year medical students were randomized into two groups: 1) standard curriculum or 2) standard curriculum plus a VR module. The standard curriculum consisted of instructional literature, a video describing CVC placement, and practice on a mannequin. All subjects completed a pre-study questionnaire which recorded their demographic data, history of VR and video game use, and self-perception of procedural ability. Participants in the VR group were assessed on CVC placement on a mannequin before and after completing the VR module. While the VR group completed the simulation, the control group was allowed to re-review the instructional material before being assessed on CVC placement. Then, all subjects completed a post-study questionnaire. 

Results
There were no differences in any baseline characteristics including years of clinical experience, prior CVC experience, or VR familiarity. Similarly, there were no differences in any procedural metrics, such as completion time, between groups or in the VR group crossover analysis. The VR group rated their system as significantly easier to use than the standard group rated the mannequin. Further, using a system usability scale (SUS), the VR system was found to be superior. Specifically, VR participants thought the system had well-integrated functions and was less cumbersome than the mannequin. Lastly, the VR group matched the standard group regarding improved comfort with placing a central line. Both groups rated their comfort significantly higher on the post-survey compared to the pre-survey. 

Conclusion
In conclusion, an instructional VR module can be a valuable addition for teaching CVC placement at the medical student level. The VR system ranked higher on the SUS compared to the mannequin, in fact, its score was slightly better than that of an inhaler as defined by previous literature. Medical students thought that the VR was easy to use, had streamlined functionality, was less cumbersome than a mannequin and improved their comfort placing a CVC. 


Leveraging Virtual Reality in Medical Education: The Feasibility of Using Virtual Reality Simulations for Teaching Medical Students Central Venous Catheter Placement

Background
Though rare, power outages in the operating room happen, perhaps at increased frequency due to more extreme weather related to climate change. These situations are dangerous and anesthesiologists must be prepared to manage them. However, evidence suggests that anesthesiologists are insufficiently prepared to manage a power outage and 85% desire more training. This problem could be solved during residency, yet many programs overlook power outage training. Thus, the objective of this study was to fill this training gap by designing a power outage simulation for anesthesiology residents and then assess whether the simulation improved confidence in power outage management.

Methods
Our team designed a high-fidelity power outage simulation for PGY-3 and PGY-4 anesthesiology residents. The simulation case involved an intraoperative power loss during an inguinal hernia repair of a patient under general anesthesia. This scenario took place within a simulated operating room at an academic simulation center and included a mannequin as the patient under general anesthesia, a surgeon actor, and a simulation specialist. After the simulation, a debriefing focused on power outage management specifics was led by an anesthesiology faculty member. Once debriefing concluded, the residents completed five-point Likert scale surveys to assess before and after confidence in several aspects of intraoperative power loss management including operating room management, monitoring vital signs, and patient disposition planning. Data were analyzed using a two-tailed paired t-test.

Results
Twenty-two anesthesiology residents completed the simulation over two years. Residents' mean confidence in managing a patient in the operating room during a power outage improved by 1.23 points (p=0.001), confidence in monitoring vital signs during a power outage improved by 1.37 points (p=0.001), and confidence in planning appropriate patient disposition during a power outage improved by 0.88 points (p=0.001). After the simulation, 100% of residents strongly agreed or agreed that they could confidently manage a patient in the operating room during a power outage, compared to just 45.5% before the simulation.

Conclusion
It is essential to address anesthesiologists’ desire for further power outage training and this simulation seems to fill the power outage training gap. After participating, residents felt confident in their power outage management skills. Other residency programs may consider implementing this simulation. A limitation of the study is that it relied solely on self-reported measures to ascertain simulation effectiveness; thus, future research could involve conducting objective performance assessments such as standardized tests or direct observation of clinical practice.

Power Outage: A Simulation Case for Anesthesiology Residents

Background: The decision to undergo labor epidural analgesia (LEA) is a significant aspect of childbirth planning for many pregnant individuals. With the rise of social media, platforms like Instagram, Facebook, and Twitter have become popular sources of information and personal narratives. These platforms provide a space for patients, healthcare professionals, and organizations to share educational content, personal experiences, and professional advice. However, the influence of these social media posts on the decision-making process of expectant mothers regarding LEA remains unclear. In this study, we intend to report the recent trends in online portrayal of LEA and the entities posting this content.

Methods: Public posts on Instagram, Facebook, and Twitter made between 1/1/2022 and 12/31/2022 using the search terms #epidural, #naturalbirth, and #unmedicatedbirth were categorized. Data was collected by three independent reviewers, each focusing on one platform. Posts were categorized by media type, perspective (patient, family/friend, physician, etc.), timing (prepartum, peripartum, postpartum), and tone (persuasive positive, persuasive negative, reflective, neutral). Data analysis was performed using Microsoft Excel to identify patterns in how social media content influences the choice to undergo labor epidural analgesia.

Results: It was found that on Twitter and Facebook, patients were the primary perspective (60% and 59%, respectively), and the tone was mainly reflective (67.7% and 54.9% respectively). For Instagram, doulas yielded the majority perspective (30.4%) while the tone remained neutral (52.9%). Posts on all three forms of social media occurred overwhelmingly in the postpartum period. Reviewers searched for the maximum number of results yielded by each search term, with Instagram generating the most results concerning #unmedicatedbirths. In contrast, Facebook and Twitter results were mainly obtained using the search term #epidural.

Conclusion: This study indicates that social media platforms have distinct user demographics and tones when discussing labor epidural analgesia. Facebook predominantly features postpartum patient perspectives with a reflective tone, suggesting it serves as a platform for sharing personal experiences post-childbirth. Instagram, dominated by doula perspectives, provides neutral and reflective content, highlighting a more balanced view on epidural use. Twitter, similar to Facebook, primarily features patient perspectives with reflective posts in the postpartum period. The variation in content and tone across platforms highlights the need for targeted educational strategies to address the diverse audiences and their preferences on social media. These insights can help healthcare professionals better understand and engage with expectant mothers considering labor epidural analgesia.

Next from AMA Research Challenge 2024

Identifying Creator Goals and Takeaways from an Antiracism Medical Education Podcast

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