Fusion of dichotic consonants in normal-hearing and hearing-impaired listenersa).

Hearing-impaired (HI) listeners have been shown to exhibit increased fusion of dichotic vowels, even with different fundamental frequency (F0), leading to binaural spectral averaging and interference. To determine if similar fusion and averaging occurs for consonants, four natural and synthesized stop consonants (/pa/, /ba/, /ka/, /ga/) at three F0s of 74, 106, and 185 Hz were presented dichotically-with ΔF0 varied-to normal-hearing (NH) and HI listeners. Listeners identified the one or two consonants perceived, and response options included /ta/ and /da/ as fused percepts. As ΔF0 increased, both groups showed decreases in fusion and increases in percent correct identification of both consonants, with HI listeners displaying similar fusion but poorer identification. Both groups exhibited spectral averaging (psychoacoustic fusion) of place of articulation but phonetic feature fusion for differences in voicing. With synthetic consonants, NH subjects showed increased fusion and decreased identification. Most HI listeners were unable to discriminate the synthetic consonants. The findings suggest smaller differences between groups in consonant fusion than vowel fusion, possibly due to the presence of more cues for segregation in natural speech or reduced reliance on spectral cues for consonant perception. The inability of HI listeners to discriminate synthetic consonants suggests a reliance on cues other than formant transitions for consonant discrimination.

Nourish: A pilot program to support self-Efficacy, learning, and wellness during USMLE step 1 preparation.

PURPOSE: Medical trainees experience significant exam-related stress, such as preparing for the USA Licensing Medical Examination Step 1, which often negatively affects emotional health. Nourish, a novel Step 1 support program, was designed to foster improved self-efficacy and well-being during the process of studying for and taking the exam. Nourish was piloted at Oregon Health & Science University between December 2018 and February 2019. METHODS: Program elements were guided by Self-Efficacy Theory and included community building, wellness support, peer tutoring and social persuasion. Program evaluation included pre- and post-program surveys. Participation was optional and included 46 of 154 students (30%) with 40 of the 46 students (87%) completing pre and post evaluations. The pre-survey was given during the Nourish orientation in December prior to the Step 1 study period, and the post-survey was given in early February when most students had taken their exam but none had received their scores. RESULTS: While summary self-efficacy scores increased between baseline and post program (24.9 vs 27.7, p < 0.001), summary emotional health scores worsened (8.15 vs 8.75, p = 0.03). Summary scores for physical health also dropped but this difference was not statistically significant. Summary perceived stress scores increased from 15.5 at baseline to 23.7 post program (p < 0.001). All students who routinely participated in Nourish passed their USMLE Step 1 exam. One student who participated only in the orientation session did not pass. CONCLUSION: Nourish appeared to improve self-efficacy, even though students reported being stressed with low emotional health. The program appeared to help students align task demands with their own personal resources and set reasonable expectations and strategies to pass the exam. Medical schools should consider similar peer- and faculty mentor-based wellness and tutoring programs to support medical students while they work to achieve academic success.