Emotional responses to COVID-19 stressors increase information avoidance about an important unrelated health threat.

The COVID-19 pandemic, like other crises, has had direct and indirect impacts on individuals, many of which have been negative. While a large body of research has examined the impacts of COVID-19 on people's lives, there is little evidence about how COVID-19 affects decision-making broadly. Emotional responses to COVID-19-related stressors, such as illness and income loss, provide a pathway for these stressors to affect decision-making. In this study, we examine linkages between exposure to COVID-19-related stressors-focusing on temporally specific local case counts and loss of income due to the pandemic-and decisions to access information about antimicrobial resistance (AMR), another critically important health issue. COVID-19 constitutes a natural experiment in that people's exposure to stressors does not result from those individuals' current decisions. Using a nationally representative survey with 1223 respondents in December 2020, we linked the temporally specific COVID-19 cases and income loss experienced by participants to an increased likelihood of feeling hopeless. Higher feelings of hopelessness led to a higher probability of avoiding information about AMR. A mediation analysis confirms that emotional responses to COVID-19 stressors significantly increase information avoidance about an unrelated, but important health issue. Our results suggest that large-scale crises, like COVID-19 and climate change, may diminish action on other important health issues facing humanity.

The personalities of most medical students are suited to rural practice: Implications for rural education program recruitment.

Introduction: The success of rural longitudinal integrated clerkship (LIC) programs has contributed to our understanding of selecting and training students for rural practice. Studies have explored the personality traits of students who participate in rural LICs although few have compared them with classmates who have not. The purpose is to compare personalities of four successive cohorts of students in the LIC Rural Physician Associate Program (RPAP) with their non-RPAP classmates. Methods: In a longitudinal cross-sectional design, medical students RPAP and non-RPAP, from 2013 to 2017 completed identical questionnaires comprising measures of personality, perfectionism, ambiguity tolerance, and resilience. T-tests, ANOVA, and post-hoc tests compared groups. K-means cluster analysis identified profiles of traits. Results: Total sample 286; RPAP = 128; non-RPAP = 158. Gender and age proportions were not different between groups. RPAP students were significantly lower in levels of perfectionism and higher in cooperativeness compared to non-RPAP classmates. Similar proportions of both groups were distributed across three personality profiles detected. Conclusions: Lower perfectionism implies advantages for rural practice. Nevertheless, similarities between groups suggest that most students would be successful in rural practice. More encouragement to all students may improve uptake of rural LICs. Greater attention to issues that affect decisions to explore rural medical education, particularly for our next generation of students, is required.

Personality profiles of rural longitudinal integrated clerkship students who choose family medicine.

BACKGROUND AND OBJECTIVES: Physician workforce projections fuel interest in addressing the shortage of family physicians. Copious research has investigated personality as a variable influencing specialty intention. Medical school rural longitudinal integrated clerkships (LICs) nurture interest in family medicine. This study examined whether rural LIC students who intended to and eventually matched into family medicine portrayed a personality trait profile different from rural LIC students who intended or matched to all other specialities. The profiles of four successive cohorts are described in relation to their intended and eventual specialty match. METHODS: A cross-sectional design sampled 145 third-year students from 2008--2011. A survey measured demographics, temperament and character personality traits, and Other-Oriented Empathy. Multivariate analysis compared family medicine versus all other specialty matches and original specialty intention with eventual match. RESULTS: Match groups did not differ in gender, age, or marital status. Rural LIC students who matched in family medicine had lower levels of Harm Avoidance, higher Reward Dependence, and nonsignificant higher levels of every other personality trait in comparison to other matches. Rural LIC students who intended and matched to family medicine showed the highest levels of Reward Dependence (warm sociability) and Other-Oriented Empathy compared to any other specialty. CONCLUSIONS: Lower levels of Harm Avoidance are conducive to less anxiety, more composure and confidence in making decisions, and being relaxed in accepting a degree of risk and uncertainty. Such calm optimism along with higher Reward Dependence showing social warmth and empathy are desirable traits for family physicians regularly confronted with a wide range of presentations from the obvious to complex. Further investigation of what influences sustainability of the intention to enter family medicine may be useful to educators for counseling.

Toward a global understanding of students who participate in rural primary care longitudinal integrated clerkships: considering personality across 2 continents.

PURPOSE: Medical schools worldwide have developed rural primary care immersive experiences to nurture students' interest in future rural careers and address workforce shortages. Few studies have looked at the students who participate in these programs. This study explores personality traits in US and Australian students who undertake rural-focused medical training. METHODS: A cross-sectional cohort design used the Temperament and Character Inventory to identify levels of the 7 basic dimensions of personality. Data were collected in successive cohorts over 2007-2011. Multivariate analysis compared trait levels between groups and by demographic variables. FINDINGS: The majority of the 302 students (US-167; Australia-135) were female, aged 20-29 years and single. A greater proportion of US students reported being partnered, living longest in a small rural/remote community and having a rural background. Significant differences between groups were detected in several traits but effect sizes were small. The personality pattern of the combined sample indicates students with a mature and stable personality high in Self-Directedness, Persistence, and Cooperativeness. Rural background and marital status enhanced this pattern. CONCLUSIONS: Despite coming from different educational and societal backgrounds, similar personality patterns are evident in US and Australian students who pursue rural medical education. Data provide support for a pattern of traits associated with a rural background and its predictive influence on interest in rural practice. Considering the international expansion of rural longitudinal integrated clerkships, understanding student attributes may assist in identifying strategies to enhance the rural workforce that are relevant across cultures and continents.

Surgical skills acquisition: performance of students trained in a rural longitudinal integrated clerkship and those from a traditional block clerkship on a standardized examination using simulated patients.

OBJECTIVES: Rural longitudinal integrated clerkship (LIC) programs for third-year medical students provide strong educational curricula and can nurture interest in rural surgical practice. Students learn technical skills in an apprenticeship model. Variability in instruction and patient experiences across sites, coupled with a lack of simulation facilities, raise some concerns about technical skill development. To explore the adequacy of skills acquisition for students in the University of Minnesota Rural Physician Associate Program (RPAP), this study compared RPAP students' performance on a scenario-based Objective Structured Assessment of Technical Skills (OSATS) with that of traditional surgery block clerkship students (Course 7500). DESIGN, SETTING, AND PARTICIPANTS: This is a nonexperimental post-only study. All enrolled students (n = 254) completed the OSATS examination. Students in the Course 7500 (n = 222) completed 15 hours of simulation skills training and supervised practice during their 6-week clerkship. RPAP students (n = 32) completed 3 hours of skills training before their 9-month rural assignment. Both groups had access to comprehensive online materials. Mean OSATS checklist, global rating, and total scores were compared at the end of training using t tests (p < 0.05). Self-reported OR and clinical experiences were explored. RESULTS: Both groups did well on the OSATS. There were no statistical differences in completion time, checklist scores, mean global ratings, or total scores. RPAP students reported significantly more days in the OR, surgery cases, and first assists. Experience with OSATS tasks reported by RPAP students during clinical rotations correlated with their OSATS performance. CONCLUSION: This study supports the viability of the LIC model for fundamental skills acquisition when augmented with introductory simulation skills training and online resources. It also suggests that simulation fills a training gap for students in a traditional surgery block clerkship program. It opens a dialog about the potential partnership of surgery departments with rural LICs to address rural general surgery shortages. Further research in this aspect is needed.

Profiles of rural longitudinal integrated clerkship students: a descriptive study of six consecutive student cohorts *.

BACKGROUND: Medical schools worldwide are challenged to address the rural primary care workforce shortage by creating community-engaged curricula to nurture student interest in rural practice. AIM: To examine the personal characteristics of six consecutive rural longitudinal integrated clerkship student cohorts to understand whom the programs attract and select and thus inform the development of such programs. METHOD: A cross-sectional cohort design was used. Six cohorts (2007-2012) completed a survey on demographics and factors that influenced their choice of rural primary care. The Temperament and Character Inventory was used to measure personality. Analysis was mainly descriptive. Where appropriate univariate analysis compared variables between groups. RESULTS: Sample size was 205 with the majority female (61%), between 25 and 29 years (64%), single (60%) and lived longest in rural communities with populations less than 20,000 (60%). Rural lifestyle, background and desire to work in underserved areas were noted to impact rural medicine interest. Professional satisfaction, personal and professional goals and family needs had the highest impact on career decisions, and financial concerns lowest. CONCLUSION: The stability of students' personal characteristics across cohorts and the workforce outcomes of this program suggest the recruitment process successfully nurtures students who will fit well into future rural practice.

Performance improvement in the perioperative system.

Hospital finance leaders should work with their organizations' perioperative leaders to implement a three-step process for identifying projects with the greatest potential for improving quality while reducing costs and increasing revenue. In essence, this process involves mapping the strategy, developing a list of potential projects, and culling projects that cannot reasonably be accomplished with available resources. The extent to which staff resources are available for such projects can best be measured using a simple spreadsheet designed for tracking special assignments of each staff member.

Management of professional boundaries in rural practice.

PURPOSE: Rural physicians wrestle with professional boundary issues routinely in everyday interactions, and their situation differs from the experience of their urban colleagues. Medical students receive limited exposure to professional boundary management in preclinical training. Increasingly, schools are implementing rural longitudinal clinical clerkships which expose students to rural boundary setting. This qualitative study explored the management of professional boundaries integral to rural practice and how this management may differ from their urban colleagues. METHOD: Semistructured interviews were conducted in 2010 with 12 rural physicians across Minnesota exploring their perceptions of professionalism in rural practice. A social constructivist approach to grounded theory was used to analyze the data. RESULTS: Five primary themes regarding rural professionalism emerged from the data: centrality of care, rural influences on choice, individualization of boundary setting, advantages of dual relationships, and disadvantages of them. These themes served to illustrate rural boundary management. CONCLUSIONS: This study's findings indicate that rural physicians are routinely confronted with professional boundary issues in everyday situations, and these circumstances do not always reflect those of their urban colleagues. Given the increase in longitudinal immersion clinical clerkship programs to nurture student interest in future rural practice, acknowledgment and acceptance of the nuances of dual relationships and boundary setting in different clinical learning contexts are vital to help students identify their personal needs for privacy and be better prepared to negotiate the realities of rural practice. These findings may inform future medical education initiatives on professional boundary setting as an aspect of professionalism.

U.S. consumers attitudes toward farm animal cloning.

In January 2008, the United States Food and Drug Administration concluded "meat and milk from cattle, swine, and goat clones or their offspring are as safe to eat as food we eat from those species now" (U.S. FDA, 2010). However, cloning remains a very controversial topic. A web-based survey administered by Knowledge Networks was used to determine U.S. consumers' awareness of and attitudes toward meat and milk from cloned cattle. Findings reveal consumers do not differentiate much between products from cloned animals and products from non-cloned animals. Overall consumers are concerned that animal cloning is an unnatural process and that it will lead to human cloning.

Is there equivalency between students in a longitudinal, rural clerkship and a traditional urban-based program?

BACKGROUND: Demonstrating the equivalency between the traditional metro-based clerkships within close proximity to the academic health center and the nontraditional rural preceptorships is important. The University of Minnesota has had a 9-month longitudinal rural elective for third-year medical students for 40 years, the Rural Physician Associate Program (RPAP). In the metro area, traditional students rotate through clerkships of 4 to 8 weeks in length. Both cohorts of students are evaluated in similar ways. METHODS: We analyzed the test scores and demographic data for two cohorts of students: RPAP (n=201) and traditional (n=1,129) who graduated between 2004 and 2009. Tests included pre-medical school data (Medical College Admission Tests, college grade point averages) as well as National Board of Medical Examiners subject examinations (shelf), US Medical Licensing Examination Step One and Two (Clinical Knowledge and Clinical Skills), and an Objective Structured Clinical Examination (OSCE). Scores were analyzed using descriptive/comparative statistics for the two groups of students. RESULTS: For the most part, RPAP students performed similarly to students in the traditional metro-based curriculum on the standard educational outcome metrics. On the obstetrics shelf, while a similar proportion of the RPAP students passed, they scored statistically significantly lower (traditional: median 72 (range 50-98) versus RPAP: 71 (51-89). DISCUSSION: This study is the largest cohort demonstrating equivalency between students taking a rural longitudinal clerkship and their metro-trained colleagues.

Qualitative differences between traditional and rural-longitudinal medical student OSCE performance.

BACKGROUND AND OBJECTIVES: To ensure adequate observation, supervision, and mentoring of trainees, long-term preceptorships or apprenticeships are being reestablished in medical education. Equivalence in academic performance has been demonstrated between longitudinal students in the Rural Physician Associate Program (RPAP), who spend 9 months in a rural community during their third year of medical school, and their peers who complete their clerkships at different hospitals and clinics (traditional). We qualitatively reviewed the end of session Objective Structured Clinical Examination (OSCE) for both groups and compared their performances. METHODS: The high and low performers on four OSCE scenarios (cough, dysuria in a teen, preventive care in an older male, medication reconciliation) for two cohorts of students: longitudinal (n=47) and traditional primary care clerkship students (n=60) were selected for review. These 16 videotapes were reviewed independently by three researchers. The themes and subthemes were discussed over four meetings. RESULTS: Both high and low scoring longitudinal students demonstrated more consistent use of rapport building skills. Longitudinal students appeared to have an effective pattern in their patient interactions and were more rehearsed at explaining preventive care recommendations such as the pros and cons of the prostate-specific antigen (PSA) test. Traditional students displayed a more complete mastery of the adolescent interview and followed a mnemonic taught during lecture. CONCLUSIONS: Qualitative assessment of OSCE data reveals information not captured in the quantitative scores. In this study, longitudinal students demonstrated better mastery of rapport building and content knowledge and had an effective routine to their patient encounters not evident in the traditional students' scenarios.

Efforts to graduate more primary care physicians and physicians who will practice in rural areas: examining outcomes from the university of Minnesota-duluth and the rural physician associate program.

PURPOSE: To compare practice choices (primary care or specialty) and practice locations (rural or metropolitan) of medical students at the Duluth and Twin Cities (Minneapolis and St. Paul; TC) campuses of the University of Minnesota (UMN). In the early 1970s, Minnesota created two medical education programs at UMN to increase the number of rural and primary care physicians: the first two years of medical school at UMN-Duluth, where the program focuses on recruiting students who will be rural family physicians, and the Rural Physician Associate Program (RPAP) elective, a nine-month, longitudinal immersion experience with a preceptor in a rural community. METHOD: In 2008, the authors analyzed outcomes for four student groups: (1) UMN-Duluth and (2) UMN-TC medical students who participated in RPAP and (3) UMN-Duluth and (4) UMN-TC students who did not participate in RPAP. UMN medical students complete their first two years on either campus; they can apply to RPAP for their third year. Non-RPAP students spend most of their third- and fourth-year rotations in the Twin Cities metropolitan area. RESULTS: The UMN-Duluth and RPAP students were most likely to select a rural location and primary care practice. UMN-TC, non-RPAP students followed national trends, choosing predominantly metropolitan and specialty practices. CONCLUSIONS: RPAP and UMN-Duluth provide significant, complementary educational programs that lead more graduates to choose rural and primary care practices. Efforts across the nation to address the crisis in rural primary care should build on these successful efforts.

Learning professionalism during the third year of medical school in a 9-month-clinical rotation in rural Minnesota.

BACKGROUND: Professionalism is now an explicit part of the medical school curricula. AIM: To examine the components that are part of developing professionalism during the Rural Physician Associate Program (RPAP) experience, a 9-month rotation in a rural community during the third year of medical school. METHODS: Two researchers analysed 3 years of essays for themes. IRB approval was obtained. RESULTS: Themes were organized using Van de Camp's model of professionalism. Students described how patients taught them about illnesses, the affects on their lives and the lives of their families. Preceptors role-modelled how to relate to patients with compassion and respect (Professionalism Towards the Patient). As a member of the health care team, clinic and hospital staff taught students how to be a good team member (Towards Other Health Care Professionals). Shadowing preceptors in their roles as physicians and community members, students learned about their responsibilities to the community (Towards the Public). Multiple opportunities for self-evaluation and reflection taught students to know themselves and find balance between work responsibilities and their personal lives (Towards Oneself). CONCLUSION: The RPAP appears to create a supportive learning environment that incorporates psychological safety, appreciation of differences, openness to new ideas and time for reflection - an ideal environment for developing professionalism.

The rural physician associate program: the value of immersion learning for third-year medical students.

CONTEXT: Changes in health care and new theories of learning have prompted significant changes in medical education. Some US medical schools employ immersion learning in rural communities to increase the number of physicians who choose to practice in these areas. Founded in 1971, the rural physician associate program (RPAP) is a longitudinal immersion learning experience for students during their third year of medical school. Students are assigned to a primary care preceptor(s) in a rural community ranging in population from 1,000 to 30,000 for 36 weeks. PURPOSE: To describe students' perceived value of this immersion learning experience. METHODS: Data from 3 classes (2004, 2005, 2006) of students (n = 95) were analyzed, including final essays that reflect on their experiences and logs of their patient encounters and procedures. Themes from students' essays related to the hands-on learning experience are presented. Frequencies of ambulatory encounters and procedures were calculated and compared with those of metropolitan area colleagues where possible. FINDINGS: The continuity experience allows for one-to-one mentoring and long-term relationships. Students see physicians, clinic/hospital staff, and patients as their teachers. The environment is nurturing, but nudges them outside their comfort zone. Students gain increasing competence with their skills and do best if they are independent and seek out learning opportunities. They report more hands-on experience, more confidence and autonomy than their peers in the metropolitan area. CONCLUSIONS: The RPAP experience provides a nurturing, longitudinal, immersion learning experience that facilitates the gradual but steady development of clinical skills alongside a personal and professional mentor.

Primary care in Minnesota: an academic health center's perspective.

Although Minnesota's overall supply of primary care physicians is as good as or better than that of many other states, Minnesotans in some rural and urban communities do not have ready access to primary care. Simply training more doctors using the current model is not a viable solution to this problem. In order to increase the supply of primary care physicians, the state, its educational institutions, and its health care provider organizations will need to develop new educational opportunities, explore new models of care, and create viable systems for health care delivery for all Minnesotans. This article describes the current status of primary care in the state and ideas for addressing anticipated workforce shortages and enhancin the vitality of primary care.

Field demonstration of DNAPL dehalogenation using emulsified zero-valent iron.

This paper describes the results of the first field-scale demonstration conducted to evaluate the performance of nanoscale emulsified zero-valent iron (EZVI) injected into the saturated zone to enhance in situ dehalogenation of dense, nonaqueous phase liquids (DNAPLs) containing trichloroethene (TCE). EZVI is an innovative and emerging remediation technology. EZVI is a surfactant-stabilized, biodegradable emulsion that forms emulsion droplets consisting of an oil-liquid membrane surrounding zero-valent iron (ZVI) particles in water. EZVI was injected over a five day period into eight wells in a demonstration test area within a larger DNAPL source area at NASA's Launch Complex 34 (LC34) using a pressure pulse injection method. Soil and groundwater samples were collected before and after treatment and analyzed for volatile organic compounds (VOCs) to evaluate the changes in VOC mass, concentration and mass flux. Significant reductions in TCE soil concentrations (>80%) were observed at four of the six soil sampling locations within 90 days of EZVI injection. Somewhat lower reductions were observed at the other two soil sampling locations where visual observations suggest that most of the EZVI migrated up above the target treatment depth. Significant reductions in TCE groundwater concentrations (57 to 100%) were observed at all depths targeted with EZVI. Groundwater samples from the treatment area also showed significant increases in the concentrations of cis-1,2-dichloroethene (cDCE), vinyl chloride (VC) and ethene. The decrease in concentrations of TCE in soil and groundwater samples following treatment with EZVI is believed to be due to abiotic degradation associated with the ZVI as well as biodegradation enhanced by the presence of the oil and surfactant in the EZVI emulsion.