Hidden curricula in academic medicine: Streamlining success for early career scholars from majority and diverse backgrounds.

The hidden curriculum (HC), or implicit norms and values within a field or institution, affects faculty at all career stages. This study surveyed affiliates of a junior faculty training program (n = 12) to assess the importance of HC topics for junior faculty, mentors, and institutional leaders. For non-diverse junior faculty and their mentors, work-life balance, research logistics, and resilience were key HC topics. Coping with bias and assertive communication were emphasized for diverse junior faculty and mentors. Institutional norms and vision were essential for leaders, while networking was important for all groups. Future research should explore HC needs and potential interventions.

Gender relativism: How context shapes what is seen as male and female.

This research explores the concept of gender relativism, whereby "gender"-or what is seen as "male" and "female"-changes as a function of context. Seven studies find that people attach gender to seemingly "gender-neutral" stimuli-bifurcating information by "male" and "female"-but that the gender of the stimuli changes as a function of the comparison set. Using stimuli from past work, including shapes (Study 1), species (Study 2), "gender-neutral" traits (Studies 3-4), faces (Study 5), and names (Studies 6-7), these studies demonstrate that gender is relative, where characteristics deemed "female" or "male" exist within a given context. Importantly, these relative evaluations shift perceptions of both gender (i.e., stereotypes) and physical sex (i.e., height, weight) characteristics, with downstream consequences for bias and target judgments (Studies 4-7). In contrast to most work in psychology, which studies gender as an independent variable (to predict differences in stereotypes and outcomes), this work calls for gender to also be considered as a dependent variable that can change as a function of context. Together, these results have theoretical implications for the construct and measurement of gender in psychology, as well as practical implications for gender stereotyping, bias, and discrimination. (PsycInfo Database Record (c) 2023 APA, all rights reserved).

Factors that contribute to disparities in time to acute leukemia diagnosis in young people: an in depth qualitative interview study.

BACKGROUND: Racial and ethnic disparities in outcomes for Black and Hispanic children with acute leukemia have been well documented, however little is known about the determinants of diagnostic delays in pediatric leukemia in the United States. The primary objective of this study is to identify factors contributing to delays preceding a pediatric leukemia diagnosis. METHODS: This qualitative study utilized in-depth semi-structured interviews. Parents and/or patients within two years of receiving a new acute leukemia diagnosis were asked to reflect upon their family's experiences preceding the patient's diagnosis. Subjects were purposively sampled for maximum variation in race, ethnicity, income, and language. Interviews were analyzed using inductive theory-building and the constant comparative method to understand the process of diagnosis. Chart review was conducted to complement qualitative data. RESULTS: Thirty-two interviews were conducted with a diverse population of English and Spanish speaking participants from two tertiary care pediatric cancer centers. Parents reported feeling frustrated when their intuition conflicted with providers' management decisions. Many felt laboratory testing was not performed soon enough. Additional contributors to delays included misattribution of vague symptoms to more common diagnoses, difficulties in obtaining appointments, and financial disincentives to seek urgent or emergent care. Reports of difficulty obtaining timely appointments and financial concerns were disproportionately raised among low-income Black and Hispanic participants. Comparatively, parents with prior healthcare experiences felt better able to navigate the system and advocate for additional testing at symptom onset. CONCLUSIONS: While there are disease-related factors contributing to delays in diagnosis, it is important to recognize there are multiple non-disease-related factors that also contribute to delays. Evidence-based approaches to reduce outcome disparities in pediatric cancer likely need to start in the primary care setting where timeliness of diagnosis can be addressed.

What does it mean to be (seen as) human? The importance of gender in humanization.

What does it mean to be (seen as) human? Ten studies explore this age-old question and show that gender is a critical feature of perceiving humanness, being more central to conceptions of humanness than other social categories (race, age, sexual orientation, religion, disability). Our first six studies induce humanization (i.e., anthropomorphism) and measure social-category ascription. Across different manipulations (e.g., having participants recall experiences, observe moving shapes, imagine nonhuman entities as people, and create a human form), we find that gender is the most strongly ascribed social category and the one that uniquely predicts humanization. To provide further evidence that gender is central to conceptions of personhood, and to examine the consequences of withholding it, we then demonstrate that removing gender from virtual humans (Study 5), human groups (Study 6), alien species (Study 7), and individuals (Study 8) leads them to be seen as less human. The diminished humanness ascribed to nongendered and genderless targets is due, at least in part, to the lack of a gender schema to guide facile and efficient sensemaking. The relative difficulty perceivers had in making sense of nongendered targets predicted diminished humanness ratings. Finally, we demonstrate downstream consequences of stripping a target of gender: Perceivers consider them less relatable and more socially distant (Study 8). These results have theoretical implications for research on gender, (de)humanization, anthropomorphism, and social cognition, more broadly. (PsycInfo Database Record (c) 2022 APA, all rights reserved).

Hiring women into senior leadership positions is associated with a reduction in gender stereotypes in organizational language.

Women continue to be underrepresented in leadership positions. This underrepresentation is at least partly driven by gender stereotypes that associate men, but not women, with achievement-oriented, agentic traits (e.g., assertive and decisive). These stereotypes are expressed and perpetuated in language, with women being described in less agentic terms than men. The present research suggests that appointing women to the top tiers of management can mitigate these deep-rooted stereotypes that are expressed in language. We use natural language processing techniques to analyze over 43,000 documents containing 1.23 billion words, finding that hiring female chief executive officers and board members is associated with changes in organizations' use of language, such that the semantic meaning of being a woman becomes more similar to the semantic meaning of agency. In other words, hiring women into leadership positions helps to associate women with characteristics that are critical for leadership success. Importantly, our findings suggest that changing organizational language through increasing female representation might provide a path for women to break out of the double bind: when female leaders are appointed into positions of power, women are more strongly associated with the positive aspects of agency (e.g., independent and confident) in language but not at the cost of a reduced association with communality (e.g., kind and caring). Taken together, our findings suggest that female representation is not merely an end, but also a means to systemically change insidious gender stereotypes and overcome the trade-off between women being perceived as either competent or likeable.

Development and testing of a survey measure of organizational perinatal patient-centered care culture.

OBJECTIVE: To develop and test a measure of patient-centered care (PCC) culture in hospital-based perinatal care. DATA SOURCES: Data were obtained from US perinatal hospitals: one provided survey development data and 14 contributed data for survey testing. STUDY DESIGN: We used qualitative and quantitative methods to develop the mother-infant centered care (MICC) culture survey. Qualitative methods included observation, focus group, interviews, and expert consultations to adapt items from other settings and create new items capturing dimensions of PCC articulated by The Commonwealth Fund. We quantitatively assessed survey psychometric properties using reliability (Cronbach's α and Pearson correlation coefficients) and validity (exploratory and confirmatory factor analysis [CFA]) statistics, and refined the survey. After confirming aggregation suitability (ICCs), we calculated "MICC culture scores" at the individual, unit, and hospital level and assessed associations between scores and survey-collected, staff-reported outcomes to evaluate concurrent validity. DATA COLLECTION: Survey development included 12 site-visit observations, one semi-structured focus group (five participants), two semi-structured interviews, five cognitive interviews, and three expert consultations. Survey testing used online surveys administered to obstetric and neonatal unit staff (N = 316). PRINCIPAL FINDINGS: Using responses from 10 hospitals with ≥4 responses from both units (n = 240), the 20-item MICC culture survey demonstrated reliability (Cronbach's α = 0.95) while capturing all PCC dimensions (subscale Cronbach's α = 0.72-0.87). CFA showed validity through goodness-of-fit (overall chi-square = 214 [p-value = 0.012], SRMR = 0.056, RMSEA = 0.041, CFI = 0.97, and TLI = 0.96). Aggregation statistics (ICCs < 0.05) justify unit- and hospital-level aggregation. Demonstrating preliminary validity, individual-, unit-, and hospital-level MICC culture scores were associated with all outcomes (satisfaction with care provided, within-unit team effectiveness, and relational coordination [RC] between units) (p-values < 0.05), except for neonatal unit scores and RC (p-value = 0.11). CONCLUSIONS: The MICC culture survey is a psychometrically sound measure of PCC culture for hospital-based perinatal care. Survey scores are associated with staff-reported outcomes. Future studies with patient outcomes will aid identification of improvement opportunities in perinatal care.

Equality for (almost) all: Egalitarian advocacy predicts lower endorsement of sexism and racism, but not ageism.

Past research has assumed that social egalitarians reject group-based hierarchies and advocate for equal treatment of all groups. However, contrary to popular belief, we argue that egalitarian advocacy predicts greater likelihood to support "Succession"-based ageism, which prescribes that older adults step aside to free up coveted opportunities (e.g., by retiring). Although facing their own forms of discrimination, older individuals are perceived as blocking younger people, and other unrepresented groups, from opportunities-that in turn, motivates egalitarian advocates to actively discriminate against older adults. In 9 separate studies (N = 3,277), we demonstrate that egalitarian advocates endorse less prejudice toward, and show more support for, women and racial minorities, but harbor more prejudice toward (Studies 1 and 2), and show less advocacy for (Studies 3-6), older individuals. We demonstrate downstream consequences of this effect, such as support for, and resource allocation to, diversity initiatives (Studies 3-6). Further, we isolate perceived opportunity blocking as a critical mediator, demonstrating that egalitarian advocates believe that older individuals actively obstruct more deserving groups from receiving necessary resources and support to get ahead (Studies 4-6). Finally, we explore the intersectional nature of this effect (Study 7). Together this research suggests that when it comes to egalitarianism, equality for all may only mean equality for some. (PsycInfo Database Record (c) 2022 APA, all rights reserved).

The Primacy of Gender: Gendered Cognition Underlies the Big Two Dimensions of Social Cognition.

It is notable that across distinct, siloed, and disconnected areas of psychology (e.g., developmental, personality, social), there exist two dimensions (the "Big Two") that capture the ways in which people process, perceive, and navigate their social worlds. Despite their subtle distinctions and nomenclature, each shares the same underlying content; one revolves around independence, goal pursuit, and achievement, and the other revolves around other-focus, social orientation, and desire for connection. Why have these two dimensions emerged across disciplines, domains, and decades? Our answer: gender. We argue that the characteristics of the Big Two (e.g., agency/competence, communion/warmth) are reflections of psychological notions of masculinity and femininity that render gender the basis of the fundamental lens through which one sees the social world. Thus, although past work has identified the Big Two as a model to understand social categories, we argue that gender itself is the social category that explains the nature of the Big Two. We outline support for this theory and suggest implications of a gendered cognition in which gender not only provides functional utility for cognitive processing but simultaneously enforces gender roles and limits men and women's opportunities. Recognizing that the Big Two reflect masculinity and femininity does not confine people to act in accordance with their gender but rather allows for novel interventions to reduce gender-based inequities.

Medication Utilization at School Age for Children Born Preterm.

We explored medication use by children born preterm at 5-8 years of age. Compared with children born at full term, children born preterm had higher medication use that included most therapeutic classifications. Although asthma and chronic lung disease influenced use, prematurity remained an independent risk factor.

Understanding Diversity Ideologies From the Target's Perspective: A Review and Future Directions.

We present a review of the diversity ideologies literature from the target's perspective. In particular, we focus on how diversity ideologies-beliefs or organizational practices with regards to how to approach diversity-affect racial minorities' and women's self-perceptions and experiences at work. This review suggests that a diversity aware ideology (i.e., multiculturalism) is more beneficial than a diversity blind ideology (i.e., colorblindness) for racial-ethnic minorities (e.g., better performance outcomes; more psychological engagement, inclusion, and workplace satisfaction; more positive leadership self-perceptions; and reduced perceptions of bias and turnover intentions). In contrast, for women, gender-blindness is associated with more positive outcomes than gender awareness (e.g., enhanced self-confidence, pro-active behaviors and leadership emergence). Importantly, multiculturalism and gender-blindness can both produce negative side effects for racial minorities and women, respectively, which highlights the importance of developing approaches to address the shortcomings of these conventional ideologies. We discuss the implications and offer recommendations for future research.

Intersectional Escape: Older Women Elude Agentic Prescriptions More Than Older Men.

Both older individuals and women are proscribed from engaging in power-related behaviors, with women proscribed from behaving agentically and older individuals expected to cede desirable resources through "Succession." However, little is known about whether these overlapping agency prescriptions equally target men and women across the lifespan. In seven studies, we find that older men face the strongest prescriptions to behave less agentically and cede resources, whereas older women are comparatively spared. We show that agency prescriptions more strongly target older men, compared to older women (Studies 1a, 1b, 2) and their younger counterparts (Studies 3 and 4) and examine social and economic consequences for agentic behavior in political, economic, and academic domains. We also find that older men garner more extreme (i.e., polarized) reactions due to their greater perceived resource threat (Studies 4-6). We conclude by discussing theoretical implications for diversity research and practical considerations for accommodating the fast-aging population.

Dehumanizing Gender: The Debiasing Effects of Gendering Human-Abstracted Entities.

The propensity to "gender"-or conceptually divide entities by masculinity versus femininity-is pervasive. Such gendering is argued to hinder gender equality, as it reifies the bifurcation of men and women into two unequal categories, leading many to advocate for a "de-gendering movement." However, gendering is so prevalent that individuals can also gender entities far removed from human sex categories of male and female (i.e., weather, numbers, sounds) due to the conceptual similarities they share with our notions of masculinity and femininity (e.g., tough, tender). While intuition might predict that extending gender to these (human-abstracted) entities only further reinforces stereotypes, the current work presents a novel model and evidence demonstrating the opposing effect. Five studies demonstrate that gendering human-abstracted entities highlights how divorced psychological notions of gender are from biological sex, thereby decreasing gender stereotyping and penalties toward stereotype violators, through reducing essentialist views of gender. Rather than "de-gendering" humans, we demonstrate the potential benefits of "dehumanizing gender."

Perspectives of Low Socioeconomic Status Mothers of Premature Infants.

BACKGROUND AND OBJECTIVES: Transitioning premature infants from the NICU to home is a high-risk period with potential for compromised care. Parental stress is high, and families of low socioeconomic status may face additional challenges. Home visiting programs have been used to help this transition, with mixed success. We sought to understand the experiences of at-risk families during this transition to inform interventions. METHODS: Mothers of infants born at <35 weeks' gestation, meeting low socioeconomic status criteria, were interviewed by telephone 30 days after discharge to assess caregiver experiences of discharge and perceptions of home visitors (HVs). We generated salient themes by using grounded theory and the constant comparative method. Interviews were conducted until thematic saturation was achieved. RESULTS: Twenty-seven mothers completed interviews. Eighty-five percent were black, and 81% had Medicaid insurance. Concern about infants' health and fragility was the primary theme identified, with mothers reporting substantial stress going from a highly monitored NICU to an unmonitored home. Issues with trust and informational consistency were mentioned frequently and could threaten mothers' willingness to engage with providers. Strong family networks and determination compensated for limited economic resources, although many felt isolated. Mothers appreciated HVs' ability to address infant health but preferred nurses over lay health workers. CONCLUSIONS: Low-income mothers experience significant anxiety about the transition from the NICU to home. Families value HVs who are trustworthy and have relevant medical knowledge about prematurity. Interventions to improve transition would benefit by incorporating parental input and facilitating trust and consistency in communication.

Use of Gastroesophageal Reflux Medications in Premature Infants After NICU Discharge.

OBJECTIVES: To describe the epidemiology and management of gastroesophageal reflux (GER) medications started in the first year of life for premature infants. METHODS: Retrospective review of a cohort of infants ≤35 weeks' gestation presenting for care by 168 days of age to a 30-site network between 2005 and 2009 (n = 2217) and followed to 3 years of age. Medication frequency, types, and duration of use were assessed. Logistic regression identified factors associated with treatment. RESULTS: Thirty-seven percent (812) were prescribed GER medications with 77% begun after NICU discharge. Ninety percent (727) received histamine-2 receptor antagonists, 33% (269) proton pump inhibitors, 22% (182) prokinetics; 40% (325) received >1 medication. Outpatient medication was initiated at 95 ± 69 days of life for total of 294 ± 249 days (interquartile ratio: 117-359). Feeding issues (adjusted odds ratio [aOR] 2.05, 95% confidence interval [CI]: 1.24-3.39) were associated with outpatient initiation. Forty-three percent (322) of infants started before 6 months were still on at 1 year of age associated with gestational age <32 weeks (aOR 1.76, 95% CI: 1.16-2.67), chronic lung disease (aOR 2.59, 95% CI: 1.29-5.22), and reactive airways disease (aOR 1.67, 95% CI: 1.05-2.65). CONCLUSIONS: Of the 37% of the cohort on GER medications, 77% were started after NICU discharge with prolonged use of medications. Feeding difficulties were associated with starting medication and markers of chronic lung disease with continuation of treatment. With uncertain evidence of efficacy, use of these medications in a high-risk population should be carefully evaluated.

Preterm Infant Attendance at Health Supervision Visits.

OBJECTIVES: To assess the adherence of premature infants with the American Academy of Pediatrics health supervision visit schedule, factors affecting adherence, and the association of adherence with preventive care. METHODS: Retrospective cohort of all infants ≤35 weeks' gestation, born 2005 to 2009, receiving care at a 30-site primary care network for at least 24 months (n = 1854). Adherence was defined as having a health supervision visit within each expected time period during the first 18 months of life. Logistic regression identified sociodemographic and medical factors associated with nonadherence and risk-adjusted association between nonadherence and outcomes. RESULTS: Only 43% received all expected health supervision visits. Those with Medicaid insurance (adjusted odds ratio [AOR] 0.46, 95% confidence interval [CI] 0.35-0.60), a visit without insurance (AOR 0.46, 95% CI 0.32-0.67), chronic illness (AOR 0.7, 95% CI 0.51-0.97), and black race (AOR 0.7, 95% CI 0.50-0.98) were less adherent, whereas provider continuity of care (AOR 2.89, 95% CI 1.92-4.37) and lower birth weight (AOR 1.67, 95% CI 1.02-2.73) increased adherence. Infants <100% adherent were less likely to be up to date with immunizations and receive recommended preventive care. In nearly half of missed visit windows, no health supervision visit was scheduled. CONCLUSIONS: Fewer than half of premature infants were fully adherent with the preventive health schedule with associated gaps in health monitoring and immunization delays. These data suggest the importance of health supervision visits and the need to explore scheduling facilitators for those at risk for nonadherence.

Lessons for providers and hospitals from Philadelphia's obstetric services closures and consolidations, 1997-2012.

The Affordable Care Act is triggering an increase in hospital consolidation and mergers. How other hospitals respond to these disruptions in supply could influence patient outcomes. We examined the experience of Philadelphia County, Pennsylvania (coterminous with the city of Philadelphia), where thirteen of nineteen hospital obstetric units closed between 1997 and 2012. Between October 2011 and January 2012 we interviewed twenty-three key informants from eleven hospitals (six urban and five suburban) whose obstetric units remained open, to understand how the large number of closures affected their operations. Informants reported having confronted numerous challenges as a result of the obstetric unit closures, including sharp surges in delivery volume and an increase in the proportion of patients with public insurance or no insurance. Informants reported adopting a number of strategies, such as innovative staffing models, to cope with the added demand brought about by the closure of nearby obstetric units. Informants emphasized that interhospital communication could mitigate closures' stresses on the health care system. Our study supports the need for policy makers to anticipate reductions in supply and monitor patient outcomes.

"I'm a keep rising. I'm a keep going forward, regardless": exploring Black men's resilience amid sociostructural challenges and stressors.

A growing number of health and social science research findings document Black men's adversities, but far less is known about their strengths. The purpose of this study was to explore resilience among low-income, urban, Black men. Semistructured interviews produced rich narratives, which uncovered numerous sociostructural stressors in men's lives, such as racism, incarceration, and unemployment. Most men were resilient despite these challenges, however, and described five main forms of resilience: (a) perseverance; (b) a commitment to learning from hardship; (c) reflecting and refocusing to address difficulties; (d) creating a supportive environment; and (e) drawing support from religion/spirituality. Analysis of men's challenge and resilience narratives revealed the need to understand and promote low-income, urban, Black men's resilience via a broader ecosocial perspective which acknowledges the importance of social and community-level protective factors to support individual men's efforts to survive and thrive amid their adversities.

Professional development using student-led, community-based activities.

As a community health education center affiliated with an academic institution, we recognize that by investing in the professional development of our students, we not only maximize our own outcomes but those of our students as well. Our project, Creating Community Connections, was developed to aid the work of our Center in characterizing the evolving community landscape following Hurricane Katrina while providing opportunities for students to engage in experiential learning. Students in the project could gain skills in program planning and community assessment, as well as leadership and communications. Twenty-three students worked on the project during its 2 years, developing data collection tools, organizing and conducting key informant interviews, facilitating focus groups and community forums, managing data, and summarizing project findings for community presentations. Participation in this project allowed our students to grow as public health leaders and researchers while gaining a greater appreciation for community collaboration.

Amplification of autoimmune response through induction of dendritic cell maturation in inflamed tissues.

Dendritic cells (DCs) are essential in T cell-mediated destruction of insulin-producing beta cells in the islets of Langerhans in type 1 diabetes. In this study, we investigated T cell induction of intra-islet DC maturation during the progression of the disease in both autoimmune-prone NOD and resistant C57BL/6 mice. We demonstrated steady-state capture and retention of unprocessed beta cell-derived proteins by semimature intra-islet DCs in both mouse strains. T cell-mediated intra-islet inflammation induced an increase in CD40 and CD80 expression and processing of captured Ag by resident DCs without inducing the expression of the p40 subunit of IL-12/23. Some of the CD40(high) intra-islet DCs up-regulated CCR7, and a small number of CD40(high) DCs bearing unprocessed islet Ags were detected in the pancreatic lymph nodes in mice with acute intra-islet inflammation, demonstrating that T cell-mediated tissue inflammation augments migration of mature resident DCs to draining lymph nodes. Our results identify an amplification loop during the progression of autoimmune diabetes, in which initial T cell infiltration leads to rapid maturation of intra-islet DCs, their migration to lymph nodes, and expanded priming of more autoreactive T cells. Therapeutic interventions that intercept this process may be effective at halting the progression of type 1 diabetes.