Barriers and Facilitators for Under-Represented in Medicine (URiM) Medical Students Interested in Surgical Sub-specialties.

Background: Little is known on drivers and detractors underrepresented in medicine (URiM) medical students face. Methods: Using the nominal group technique (NGT), we explored experiences that strengthen or weaken the enthusiasm to pursue a career in surgery among URiM medical students (October 2021- April 2022); participants voted on the three most important experiences (weight of 3= top rated, = 1 for the lowest rated). Responses from NGT with at least one vote were weighted, ranked, and categorized. Results: Seventeen students participated. Experiences that strengthen enthusiasm (36 responses with at least one vote) involved mentorship and role models (weighted sum percentage, 35%), demonstrating grit (15%), lifestyle (15%), patient interactions (14%), technical skills (11%), community and team (10%), and intellectual stimulation (1%). Experiences that weaken enthusiasm (33 responses with at least one vote) include the minority experience (weighted sum percentage, 51%), quality of life (25%), toxic environment (13%), lack of information (7%), and finances (5%). Conclusions: Mentorship, demonstrating grit, and feeling a sense of community were important positive experiences or attitudes. The minority experience, toxic environment, perceptions of self-worth, and lifestyle misconceptions perceived by URiM must be addressed to increase diversity, equity, and inclusion.

Implementation of a Problem-Based Presentation Format to Improve Residents' Ambulatory Patient Presentations.

Background: The format for residents to present hospitalized patients to teaching faculty is well defined; however, guidance for presenting in clinic is not uniform. Objective: We report the development, implementation, and evaluation of a new standardized format for presenting in clinic: the Problem-Based Presentation (PBP). Methods: After a needs assessment, we implemented the format at the teaching clinics of our internal medicine residency program. We surveyed participants on innovation outcomes, feasibility, and acceptability (pre-post design; 2019-2020; 5-point scale). Residents' primary outcomes were confidence in presentation content and presentation order, presentation efficiency, and presentation organization. Faculty were asked about the primary outcomes of resident presentation efficiency, presentation organization, and satisfaction with resident presentations. Results: Participants were 111 residents and 22 faculty (pre-intervention) and 110 residents and 20 faculty (post-intervention). Residents' confidence in knowing what the attending physician wants to hear in an outpatient presentation, confidence in what order to present the information, and how organized they felt when presenting in clinic improved (all P<.001; absolute increase of the top 2 ratings of 25%, 28%, and 31%, respectively). Residents' perceived education in their outpatient clinic also improved (P=.002; absolute increase of the top 2 ratings of 19%). Faculty were more satisfied with the structured presentations (P=.008; absolute increase of the top 2 ratings of 27%). Conclusions: Implementation of a new format for presenting in clinic was associated with increased resident confidence in presentation content, order of items, overall organization, and a perceived increase in the frequency of teaching points reviewed by attending physicians.

Impact of Virtual Interviewing on Geographic Placement for Cardiology Fellowship Recruitment.

Background Virtual interviewing for cardiology fellowship was instituted in the 2021 fellowship application cycle because of the COVID-19 pandemic and restricted travel. The impact on geographic patterns of fellow-training program matching is unknown. This study sought to determine if there was a difference in geographic placement of matched fellows for cardiology fellowship match after initiation of virtual interviews compared with in-person interviewing. Methods and Results All US-based accredited cardiovascular disease fellowship programs that participated in the 2019 to 2021 fellowship match cycles and had publicly available data with fellowship and residency training locations and training year were included. Each fellow was categorized based on whether their fellowship and residency programs were in the same institution, same state, same US census region, or different census region. Categories were mutually exclusive. Of 236 eligible programs, 118 (50%) programs were identified, composed of 1787 matched fellows. Compared with the previrtual cohort (n=1178 matched fellows), there was no difference in the geographic placement during the 2021 virtual cycle (n=609 matched fellows) (P=0.19), including the proportion matched at the same program (30.6% versus 31.5%), same state but different program (13% versus 13.8%), same region but different state (24.2% versus 19.7%), or different region (35% versus 33.1%). There was also no difference when stratified by program size or geographic region. Conclusions The use of virtual interviewing in the 2021 cardiology fellowship application cycle showed no significant difference in the geographic placement of matched fellows compared with in-person interviewing. Further study is needed to evaluate the impact of virtual interviewing and optimize its use in fellowship recruitment.

Mattress Coil Spring Fatigue and Weight-Bearing Support: Comparison of Weight-Bearing and Non-Weight-Bearing Springs.

OBJECTIVE: The purpose of this study was to compare the firmness of used mattress coil springs from the areas bearing greatest body weight versus areas subjected to little compression. METHODS: Weight-bearing springs (WBS) extracted from the center of the mattresses (N = 32), and non-weight-bearing springs (NWBS) extracted from the head/foot were of the same mattresses. To determine spring weakness, a 1296-g ingot was placed on the coil, and the compression distance was measured (cm). In addition, a gauge was used to measure the amount of pressure required to compress the coil springs a distance of 2 cm. Comparison between WBS and NWBS data were statistically treated using independent t tests and a 1-way analysis of variance. RESULTS: There were no significant group differences in weight or height in unloaded coils. However, there were significant (P < .05) differences in coil spring compression distance under load (WBS = 2.78 ± 0.34 cm; NWBS = 1.52 ± 0.39 cm) and force gauge compression (WBS = 1090.51 ± 88.42 g; NWBS = 1213.12 ± 71.38 g) between groups. CONCLUSION: This study found that WBSs were weaker when compressed than the NWBS from used mattresses, and such characteristics may not be visually apparent in a mattress when not in use. Thus, coil springs in bedding systems may eventually fail to provide the initial structural support after use. Such sagging may compromise sleep posture with accompanying poor sleep quality and quantity.

Exploring Match Space: How Medical School and Specialty Characteristics Affect Residency Match Geography in the United States.

PURPOSE: To explore how school and specialty characteristics impact the geographic match location of U.S. senior medical students. METHOD: The authors collected student match data between 2018 and 2020 from U.S. MD-granting medical schools and calculated the distance between students' medical schools and residency training programs. They use the term "match space" to describe this distance. Match space was codified on a 5-point ordinal scale by where the student matched: 1 = home institution, 2 = home state, 3 = an adjacent state, 4 = the same or adjacent U.S. Census division (and not adjacent state), and 5 = skipped at least one U.S. Census division. Ordinal logistic regression correlated school and specialty characteristics with match space. RESULTS: During the study period, 26,102 medical students, representing 66 medical schools from 28 states, matched in 23 specialties. Fifty-nine percent of students were from public institutions, and 27% of schools ranked in the top 40 of National Institutes of Health (NIH) research funding. The match space was higher for students graduating from private institutions (odds ratio [OR] 1.14; 95% confidence interval [CI], 1.06 to 1.22) and matching into more competitive specialties (OR 1.07; 95% CI, 1 to 1.14). The match space was lower for students graduating from top NIH-funded institutions (OR 0.89; 95% CI, 0.85 to 0.94) and from schools with a higher percentage of in-state matriculants (OR 0.75; 95% CI, 0.72 to 0.77). CONCLUSIONS: School characteristics such as region, public/private designation, NIH funding, and percentage of in-state students were associated with residency match geography. Matching into more competitive specialties also showed a marginal increase in match distance. These findings suggest that a student's choice of specialty and medical school may impact subsequent geographic placement for residency training, which should be considered by students and residency programs alike.

Creating Clinician Educators: Evaluation of a One-Month Medical Education Curriculum for Senior Residents.

BACKGROUND: Clinician-educator tracks improve teaching behaviors in trainees. However, detailed curriculum descriptions to fully understand, compare, and reproduce them are often lacking. We aimed to describe and evaluate a medical education curriculum for senior residents. METHODS: Based on Kolb's experiential learning model, we designed a one-month curriculum to increase teaching effectiveness. PGY 2-4 internal medicine and medicine-pediatrics residents in a university-based training program participated in the course from 2015-2019. In a pre-post design, participants completed a survey to evaluate the curriculum. Survey items related to four constructs in medical education: knowledge, confidence, skills, and importance (5-point Likert scale; 1=low, 5=high). We assessed the difference in the means for each construct before and after the curriculum. RESULTS: Thirty-nine residents completed the curriculum (19% of total residents), and 100% of participants completed the surveys. We observed an increase in the mean self-rated level of teaching knowledge (2.63 [SD 0.57] vs. 4.43 [SD 0.42], p<0.005), confidence (3.31 [SD 0.4] vs. 4.29 [SD 0.32], p<0.005), and skills (2.9 [SD 0.63] vs. 4.14 [SD 0.38], p<0.005) after completing the course. Residents consistently graded individual curricular components highly. CONCLUSIONS: We describe a one-month medical education curriculum with a strong foundation in learning theory. The curriculum is feasible and presented in sufficient detail to allow reproduction. Our findings suggest that it increases participants' self-perceptions of teaching knowledge, confidence, and skills.

Similar Anaerobic and Aerobic Adaptations After 2 High-Intensity Interval Training Configurations: 10:5 s vs. 20:10 s Work-to-Rest Ratio.

ABSTRACT: Moghaddam, M, Estrada, CA, Muddle, TWD, Magrini, MA, Jenkins, NDM, and Jacobson, BH. Similar anaerobic and aerobic adaptations after 2 high-intensity interval training configurations: 10:5 s vs. 20:10 s work-to-rest ratio. J Strength Cond Res 35(6): 1685-1692, 2021-This study compares the effects of 2 high-intensity interval training (HIIT) configurations, a 10-5 vs. a 20-10 second work-to-rest ratio, on anaerobic and aerobic performance. Thirty-four individuals were randomly assigned to 10-5-HIIT (n = 17) and 20-10-HIIT (n = 17) groups to complete 6 cycles of 6 exercises, 3 days a week for 4 weeks. The 10-5-HIIT was performed with 10 s:5 s work-to-rest ratio with 1-minute recovery between cycles, while the 20-10-HIIT was performed with 20 s:10 s work-to-rest ratio followed by a 2-minute recovery. Anaerobic (i.e., peak power [PP], anaerobic capacity [AC], anaerobic power [AP], and total work [TW]) and aerobic fitness (i.e., time to exhaustion [TE], absolute V̇o2max [A-V̇o2max], relative V̇o2max [R-V̇o2max]) were measured with pre-training and post-training intervention. A significant main effect time was observed for both 10-5-HIIT and 20-10-HIIT (p < 0.05) in PP (9.2%, 5.7%); AC (14.9%, 8.6%); AP (9.0%, 6.2%); TW (15.1%, 8.5%); TE (4.3%, 5.5%); A-V̇o2max (9.4%, 8.9%); R-V̇o2max (8.5%, 8.2%), respectively. In conclusion, individuals may be able to achieve similar health benefits as 20-10-HIIT by performing 10-5-HIIT, despite exercising for 50% less total time. High-intensity interval training has been suggested as a "time-efficient" mode of exercise that can mitigate the most significant barrier to physical activity, "lack of time." Both 10-5-HIIT and 20-10-HIIT can induce performance adaptations to a similar extent. However, because of shorter time commitment, performing 10-5-HIIT at 10 s:5 s work-to-rest ratio may offer a shorter and equally efficient interval. Functional fitness training during HIIT protocols seems to be as beneficial as ergometer-based HIIT to improve anaerobic and aerobic performance.

Are We Measuring What Matters? How Student and Clerkship Characteristics Influence Clinical Grading.

PURPOSE: Given the growing emphasis placed on clerkship performance for residency selection, clinical evaluation and its grading implications are critically important; therefore, the authors conducted this study to determine which evaluation components best predict a clinical honors recommendation across 3 core clerkships. METHOD: Student evaluation data were collected during academic years 2015-2017 from the third-year internal medicine (IM), pediatrics, and surgery clerkships at the University of Alabama at Birmingham School of Medicine. The authors used factor analysis to examine 12 evaluation components (12 items), and they applied multilevel logistic regression to correlate evaluation components with a clinical honors recommendation. RESULTS: Of 3,947 completed evaluations, 1,508 (38%) recommended clinical honors. The top item that predicted a clinical honors recommendation was clinical reasoning skills for IM (odds ratio [OR] 2.8; 95% confidence interval [CI], 1.9 to 4.2; P < .001), presentation skills for surgery (OR 2.6; 95% CI, 1.6 to 4.2; P < .001), and knowledge application for pediatrics (OR 4.8; 95% CI, 2.8 to 8.2; P < .001). Students who spent more time with their evaluators were more likely to receive clinical honors (P < .001), and residents were more likely than faculty to recommend clinical honors (P < .001). Of the top 5 evaluation items associated with clinical honors, 4 composed a single factor for all clerkships: clinical reasoning, knowledge application, record keeping, and presentation skills. CONCLUSIONS: The 4 characteristics that best predicted a clinical honors recommendation in all disciplines (clinical reasoning, knowledge application, record keeping, and presentation skills) correspond with traditional definitions of clinical competence. Structural components, such as contact time with evaluators, also correlated with a clinical honors recommendation. These findings provide empiric insight into the determination of clinical honors and the need for heightened attention to structural components of clerkships and increased scrutiny of evaluation rubrics.

Does strict validation criteria for individual motor units alter population-based regression models of the motor unit pool?

The purpose of this study was to determine if the implementation of a strict validation procedure, designed to limit the inclusion of inaccuracies from the decomposition of surface electromyographic (sEMG) signals, affects population-based motor unit (MU) analyses. Four sEMG signals were obtained from the vastus lateralis of 59 participants during isometric contractions at different relative intensities [30%, 70%, and 100% of maximal voluntary contraction (MVC)], and its individual motor unit potential trains (MUPTs) were extracted. The MUPTs were then excluded (ISIval) based on the coefficient of variation and histogram of the interspike intervals (ISI), the absence of additional clusters that reveals missed or additional firings, and more. MU population-based regression models (i.e., modeling the entire motor unit pool) were performed between motor unit potential size (MUPSIZE), mean firing rate (MFR), and recruitment threshold (RT%) separately for DSDCOnly (includes all MUPTs without the additional validation performed) and ISIval data at each contraction intensity. The only significant difference in regression coefficients between DSDCOnly and ISIval was for the intercepts of the MUPSIZE/MFR at 100% MVC. The validation had no other significant effect on any of the other regression coefficients for each of the contraction intensities. Our findings suggest that even though the decomposition of surface signals leads to some inaccuracies, these errors have limited effects on the regression models used to estimate the behavior of the whole pool. Therefore, we propose that motor unit population-based regression models may be robust enough to overcome decomposition-induced errors at the individual MU level.

Muscular morphological adaptations of two whole-body high intensity interval training configurations.

BACKGROUND: High-intensity intermittent training (HIIT) has increased in popularity due to being time-efficient mode of exercise. Previous HIIT studies have mainly focused on percentage of fat loss, fat mass loss, and weight loss. However, enhancing muscle protein synthesis induced by HIIT that results in muscular morphological adaptations is a potential benefit of HIIT. This study compared the effects of two HIIT protocols on muscular morphological adaptations. METHODS: Thirty-four recreationally active participants were randomly assigned to 10-5-HIIT and 20-10-HIIT to complete 6 sets of 6 intervals. The 10-5-HIIT and 20-10-HIIT protocols were performed with 10s:5s and 20s:10s exercise-to-rest ratios and provided with 1- and 2-min recovery periods between sets, respectively. Muscle cross-sectional area (mCSA) and echo intensity (EI) of the rectus femoris (RF) and vastus lateralis (VL) were assessed via B-mode ultrasonography before and after intervention. Two-way mixed factorial ANOVAs were used for analyses. RESULTS: The 10-5-HIIT and 20-10-HIIT groups significantly (P<0.05) increased RF mCSA (change (Δ)=0.4±0.8 cm2, 8.0%; Δ=0.5±0.8 cm2, 5.5%) and VL mCSA (Δ=1.2±1.6 cm2, 9.0%; Δ=2.20±1.4 cm2, 10.4%), respectively. No significant (P>0.05) change was observed for the EI of the RF and VL. CONCLUSIONS: Whole-body HIIT can be a time-efficient exercise modality to elicit muscular morphological adaptations in the RF and VL muscles. The 10-5-HIIT protocol induced benefits comparable to those of the 20-10-HIIT, while it reduced the total exercise time by 50%.

What Defines an Honors Student? Survey of Pediatric and Internal Medicine Faculty Perspectives.

OBJECTIVE: Although considerable emphasis is placed on the attainment of honors in core medical school clerkships, little is known about what student characteristics are used by attending physicians to earn this designation. The purpose of this study was to evaluate what values and characteristics that attending physicians consider important in the evaluation of Pediatrics and Internal Medicine clerkship students for clinical honors designation. METHODS: This cross-sectional survey study was framed around Accreditation Council for Graduate Medical Education (ACGME) competencies. It was administered at three tertiary care hospitals associated with one large medical school in an urban setting. Teaching ward attendings in Pediatrics and Internal Medicine who evaluated third-year medical students between 2013 and 2016 were surveyed. RESULTS: Overall, Pediatric and Internal Medicine faculty demonstrated close agreement in which competencies were most important in designating clinical honors. Both groups believed that professionalism was the most important factor and that systems-based practice and patient care were among the least important factors. The only competency with a significant difference between the two groups was systems-based practice, with Internal Medicine placing more emphasis on the coordination of patient care and understanding social determinants of health. CONCLUSIONS: Professionalism, communication skills, and medical knowledge are the most important characteristics when determining clinical honors on Pediatrics and Internal Medicine clerkships.

Cross-education: effects of age on rapid and maximal voluntary contractile characteristics in males.

PURPOSE: The purpose of this study was to determine the effect of age on the cross-education of rapid and maximal contractile properties for the knee extensors. METHODS: Young (n = 10; age = 21.1 ± 1.7 years) and older (n = 10; age = 65.3 ± 8.3 years) males performed unilateral isokinetic resistance training (RT) of the knee extensors for 4 weeks. Maximal voluntary isokinetic (45° s-1 and 300° s-1) and isometric testing was conducted for the trained and untrained leg before and after RT. Peak torque (PT) and acceleration were obtained from isokinetic testing as well as torque at 30 ms (TQ30) and 100 ms (TQ100) from the 45° s-1 contraction. PT and rate of torque development were recorded from the isometric contractions. RESULTS: Independent of age, isometric PT (10.1%; p = 0.006) as well as PT and acceleration at 300° s-1 (6.7%; p = 0.008 and 4.0%; p = 0.016, respectively) increased in the untrained leg. At 45° s-1, acceleration was increased (3.6%; p = 0.021), but PT remained unchanged (p = 0.227). TQ100 increased similarly between groups (4.5%; p = 0.014), but TQ30 increased only in the older group (9.5%; p = 0.022). CONCLUSIONS: Cross-education of rapid and maximal contractile parameters can be achieved early during unilateral RT independent of age. These findings indicate the potential for particular unilateral RT protocols to be used for older adults in rehabilitative settings to offset disuse-related reductions in contractile function, which are most dramatic in this population.

What Attracts Medical Students to Primary Care? A Nominal Group Evaluation.

OBJECTIVE: To examine the perceptions of first-year medical students on their experiences in primary care. METHODS: Nominal group technique sessions were conducted with first-year medical students for 5 years. Questions were designed to evaluate primary care experiences and the role of primary care physicians. The questions explored what would make them consider primary care, what would detract from it, and what primary care has to offer that no other specialty can. Responses were weighted and ranked. The main outcome was the top five responses to three questions that were obtained at each session. RESULTS: Thirty-four students generated 280 responses to 3 questions. The top 5 responses for each year resulted in 29 experiences that strengthen enthusiasm: patient interactions (weighted sum, 43%), physician interactions/role modeling (22%), community interactions (20%), healthcare system/finances (8%), and other (6%). The top 5 responses resulted in 26 experiences that weaken enthusiasm, including hidden curriculum (45%), poor role models (29%), uncertainties about the healthcare system such as finances and documentation (20%), and patient interactions (6%). The top 5 responses regarding the uniqueness of primary care resulted in 37 experiences, including patient interactions (38%), continuity of care (20%), knowledge base (13%), community impact (10%), lifestyle benefits (10%), and education/prevention (9%). CONCLUSIONS: Medical students highlighted unique relationships with patients and continuity of care as experiences that increase their enthusiasm for primary care. Negative experiences that weakened enthusiasm for primary care included hidden curriculum and poor role models. Programs that provide experiences in primary care can increase student interest in primary care careers.

Signed, Sealed, Delivered: Increasing Patient Notification of Test Results in an Internal Medicine Resident Continuity Clinic.

OBJECTIVES: Informing patients of their test results is an important patient safety issue, yet many physicians perform dismally in this regard. Residents often face additional barriers to communicating test results to patients. We wanted to determine whether streamlining the notification process, communicating expectations, and having residents audit their performance would increase result notification rates. METHODS: We used a quasi-experimental design, and a single-group before-and-after intervention. Our multifold intervention consisted of development and standardization of a notification process in the electronic medical record, an education component, and a self-audit component. During a 15-minute session, we educated residents on the use of the new process. We also restated expectations regarding notifying patients of their results. Residents audited their own charts for a period before the intervention and during a second, postintervention period. An independent review of notification rates took place simultaneously as well as during an additional period several months later. RESULTS: In total, 87 residents were eligible for participation. All 87 completed the project, giving a 100% participation rate. Resident-reported laboratory test notification rates increased from 16% to 91%; other test result rates increased from 33% to 84%. The three independent reviews showed laboratory test notification rates increased from 18.5% to 71.7% to 87.1%, and notification of other test results increased from 23.5% to 66.7% to 91.7%. CONCLUSIONS: Baseline rates of notification for diagnostic tests results were low, but streamlining the notification process, clearly stating expectations for using it, and using resident self-audit can improve notification rates.

Clinical Reasoning Assessment Methods: A Scoping Review and Practical Guidance.

PURPOSE: An evidence-based approach to assessment is critical for ensuring the development of clinical reasoning (CR) competence. The wide array of CR assessment methods creates challenges for selecting assessments fit for the purpose; thus, a synthesis of the current evidence is needed to guide practice. A scoping review was performed to explore the existing menu of CR assessments. METHOD: Multiple databases were searched from their inception to 2016 following PRISMA guidelines. Articles of all study design types were included if they studied a CR assessment method. The articles were sorted by assessment methods and reviewed by pairs of authors. Extracted data were used to construct descriptive appendixes, summarizing each method, including common stimuli, response formats, scoring, typical uses, validity considerations, feasibility issues, advantages, and disadvantages. RESULTS: A total of 377 articles were included in the final synthesis. The articles broadly fell into three categories: non-workplace-based assessments (e.g., multiple-choice questions, extended matching questions, key feature examinations, script concordance tests); assessments in simulated clinical environments (objective structured clinical examinations and technology-enhanced simulation); and workplace-based assessments (e.g., direct observations, global assessments, oral case presentations, written notes). Validity considerations, feasibility issues, advantages, and disadvantages differed by method. CONCLUSIONS: There are numerous assessment methods that align with different components of the complex construct of CR. Ensuring competency requires the development of programs of assessment that address all components of CR. Such programs are ideally constructed of complementary assessment methods to account for each method's validity and feasibility issues, advantages, and disadvantages.

Age Does Not Attenuate Maximal Velocity Adaptations in the Ipsilateral and Contralateral Limbs During Unilateral Resistance Training.

This study examined the effects of unilateral resistance training (RT) on maximal velocity parameters in the ipsilateral and contralateral legs in young and older males. Young (n = 22; age = 21.55 ± 2.23 years) and older (n = 20; age = 65.10 ± 9.65 years) males were assigned to training or control groups. Unilateral isokinetic RT of the knee extensors was performed for 4 weeks. Peak velocity and acceleration were identified during a dynamic maximal voluntary contraction before (PRE), at Week 2 (MID), and after Week 4 (POST) of RT. Age-independent increases in peak velocity (1.5%) and acceleration (4.5%) were demonstrated at POST for the trained leg. For the untrained leg, acceleration increased (4.3%) at POST similarly between training groups. These findings provide evidence for the high degree of neuromuscular plasticity, regardless of age, during the early phase of RT, and the potential for cross education of acceleration.

Are All Teaching Activities Valued the Same? Their Relative Worth Is in the Eye of the Beholder.

OBJECTIVES: The pressures for generating revenue from clinical activities dissuade clinician-educators from teaching; taking the steps to develop an educational value system is a way to recognize and perhaps support education. We compared the perceived educational value of diverse pedagogical activities during clinical training from students, residents, and faculty in medical and surgical specialties. METHODS: Between 2016 and 2017, a survey among medical students, residents, and faculty from medical (internal medicine, pediatrics) or surgical (general surgery, obstetrics and gynecology) departments was conducted at an academic medical center that sponsors 88 training programs. Participants ranked teaching activities relative to their perceived teaching importance. RESULTS: In total, 156 subjects participated (48 core teaching faculty, 68 residents, and 40 medical students). Teaching in the wards was the highest-ranked teaching activity for medical (mean 1.6) and surgical specialties (mean 1.9). For medicine and pediatrics, active teaching activities were ranked higher (mean 2.9, 95% confidence interval [CI] 2.8-3.0) than passive teaching activities (mean 5.3, 95% CI 5.1-5.5, P < 0.001). Similarly, for surgery and obstetrics and gynecology, active teaching activities were ranked higher (mean 3.6, 95% CI 3.3-3.9) than passive teaching activities (mean 5.2, 95% CI 4.8-5.5, P < 0.001). CONCLUSIONS: Medical students, residents, and faculty across specialties have a high degree of agreement regarding the ranking of diverse pedagogical activities; such correlation will facilitate the interpretation of educational value units across specialties.

Engagement in an Online Cultural Competency Training.

OBJECTIVES: Engagement with online cultural competency training has not been well studied. We examined knowledge, attitudes, and skills differences among medical students, physicians, and other professionals in an online cultural competency education program. METHODS: A total of 1745 participants completed up to four online modules aimed at exploring stereotype, bias, diet, and religion among African American patients with hypertension. We examined knowledge, attitudes, and self-reported skills with 17 multiple-choice questions embedded in the 4 modules. Participants received comparative responses with their peers. RESULTS: Between 75% and 84% of participants knew the definition of stereotype and <50% knew the definition of bias (47% students, 36% physicians, 33% others, P < 0.001). Most responded that minorities perceive bias (98%-100%) and believe that evidence exists showing that bias affects decision making (62%-69%). Although most perceive that religious and spiritual beliefs affect reaction to illness often (78% students, 68% physicians, 79% others, P < 0.001), few would ask about religious beliefs during a typical encounter (13% students, 16% physicians, 30% others, P < 0.001). CONCLUSIONS: All of the participants struggled to define bias; however, most agreed that minorities perceive bias in the care they receive. We examined usage and interaction with the online content as a dimension of engagement.