Understanding Pandemic Experiences Among America's Elders.

Older Americans' experiences of the COVID-19 pandemic, including social isolation and loneliness, generosity, and resilience, must be studied and addressed.

Recommendations for Welcoming Back Nursing Home Visitors During the COVID-19 Pandemic: Results of a Delphi Panel.

OBJECTIVES: Nursing homes became epicenters of COVID-19 in the spring of 2020. Due to the substantial case fatality rates within congregate settings, federal agencies recommended restrictions to family visits. Six months into the COVID-19 pandemic, these largely remain in place. The objective of this study was to generate consensus guidance statements focusing on essential family caregivers and visitors. DESIGN: A modified 2-step Delphi process was used to generate consensus statements. SETTING AND PARTICIPANTS: The Delphi panel consisted of 21 US and Canadian post-acute and long-term care experts in clinical medicine, administration, and patient care advocacy. METHODS: State and federal reopening statements were collected in June 2020 and the panel voted on these using a 3-point Likert scale with consensus defined as ≥80% of panel members voting "Agree." The consensus statements then informed development of the visitor guidance statements. RESULTS: The Delphi process yielded 77 consensus statements. Regarding visitor guidance, the panel made 5 strong recommendations: (1) maintain strong infection prevention and control precautions, (2) facilitate indoor and outdoor visits, (3) allow limited physical contact with appropriate precautions, (4) assess individual residents' care preferences and level of risk tolerance, and (5) dedicate an essential caregiver and extend the definition of compassionate care visits to include care that promotes psychosocial well-being of residents. CONCLUSIONS AND IMPLICATIONS: The COVID-19 pandemic has seen substantial regulatory changes without strong consideration of the impact on residents. In the absence of timely and rigorous research, the involvement of clinicians and patient care advocates is important to help create the balance between individual resident preferences and the health of the collective. The results of this evidence-based Delphi process will help guide policy decisions as well as inform future research.

Healthy Aging Across the Stages of Old Age.

Healthy aging is among the key frontiers for twenty-first century geriatrics and gerontology. Gerontology is positioned to address not only disease, debility, frailty, and death but also patients' hopes to remain healthy and high functioning and optimize their wellness. Definitions, models, and metrics of healthy aging are increasingly dynamic and multidimensional, drawing from biomedicine, social sciences, older adults' perspectives, and geroscience. Given current and projected demographics, focus on healthy aging at population, health system, research, clinical, and individual levels will lower costs and burdens while improving lives. Multiple models and strategies exist to guide progress in this critical emerging area.

Evaluation of a Medical Student Research and Career Development Program to Increase Diversity in Academic Medicine.

PURPOSE: To describe and evaluate an innovative research program supported by the National Institutes of Health, "Promoting Research Opportunities Fully-Prospective Academics Transforming Health" (PROF-PATH), designed to support medical students from groups underrepresented-in-medicine (URM) interested in pursuing academic careers. METHOD: Based on social cognitive career theory (SCCT), PROF-PATH supplemented a traditional research program (TRP) by providing additional mentorship and a curriculum focused on "assumed knowledge" of academic culture, guidance with research challenges, and emotional competence. The four-year evaluation (2013-2016) consisted of pre- and postprogram surveys of PROF-PATH and TRP students, plus focus groups and individual structured interviews with PROF-PATH students. Survey questions queried students' self-confidence in research- and career-related skills and abilities. The authors mapped themes elicited in focus groups and interviews onto SCCT domains. RESULTS: Of 454 medical students, 343 (75.6%) completed the surveys. According to preprogram surveys, PROF-PATH students (n = 85) were less confident in their ability to find or manage mentor relationships than TRP students (n = 258) and less likely to report having a mentor who provided strong support for their research interests. At program's end, PROF-PATH students showed greater increases in confidence than TRP students in multiple ability domains. Qualitative analysis of themes indicated that PROF-PATH influenced students through seven SCCT domains and increased student academic career self-efficacy. CONCLUSIONS: An innovative program for URM medical students participating in mentored research was successful in supporting academic career interest and academic self-efficacy. Schools motivated to increase diversity in academic medicine should consider adapting PROF-PATH.

Perspectives of low-income chronically ill patients on complex care management.

INTRODUCTION: Low-income, chronically ill adults disproportionately experience poor health outcomes despite increased health care use and costs. Complex care management (CCM) programs are an innovative approach to improving outcomes for these patients, but little is known about the patients' experiences in CCM programs in safety net primary care settings. METHOD: The authors conducted semistructured interviews with 13 CCM participants in a safety net primary care clinic to explore their perceptions of their health and their experiences with CCM. Interviews were recorded, transcribed, independently coded, and analyzed through an iterative process using grounded theory methodology to identify themes in the participants' experiences. RESULTS: From our interviews, 3 themes emerged-(a) participants mourned the loss of physical function and social well-being as a result of poor health; (b) participants reported increased health-related motivation due to relationships with the care team; and (c) participants experienced a newfound sense of control as a result of improved care navigation and self-management. DISCUSSION: Complex care management improved health-related motivation and provided a renewed sense of control for study participants, who were experiencing the loss of physical function and social well-being due to their chronic diseases. These findings support the importance of relationship-centered care models in programs for low-income, chronically ill patients. Future research should focus on identifying and spreading best practices that effectively empower patients to feel more in control of their health. (PsycINFO Database Record

Essential steps in developing best practices to assess reflective skill: A comparison of two rubrics.

PURPOSE: Medical education lacks best practices for evaluating reflective writing skill. Reflection assessment rubrics include the holistic, reflection theory-based Reflection-on-Action and the analytic REFLECT developed from both reflection and narrative-medicine literatures. To help educators move toward best practices, we evaluated these rubrics to determine (1) rater requirements; (2) score comparability; and (3) response to an intervention. METHODS: One-hundred and forty-nine third-year medical students wrote reflections in response to identical prompts. Trained raters used each rubric to score 56 reflections, half written with structured guidelines and half without. We used Pearson's correlation coefficients to associate overall rubric levels and independent t-tests to compare structured and unstructured reflections. RESULTS: Reflection-on-Action training required for two hours; two raters attained an interrater-reliability = 0.91. REFLECT training required six hours; three raters achieved an interrater-reliability = 0.84. Overall rubric correlation was 0.53. Students given structured guidelines scored significantly higher (p < 0.05) on both rubrics. CONCLUSIONS: Reflection-on-Action and REFLECT offer unique educational benefits and training challenges. Reflection-on-Action may be preferred for measuring overall quality of reflection given its ease of use. Training on REFLECT takes longer but it yields detailed data on multiple dimensions of reflection that faculty can reference when providing feedback.