Improving Applicant Satisfaction in Orthopaedic Surgery Residency Matching: The Role of Preference Signaling.

Background: The orthopaedic surgery residency match is becoming increasingly more competitive with a disproportionate number of applicants to positions. As the residency application process has become more competitive, applicants have resorted to applying broadly to improve their chance of a successful match. Preference signaling was implemented for orthopaedic surgery for the 2022-2023 match cycle which allowed applicants to "signal" 30 programs of their choosing. Methods: The purpose of this study was to assess the impact of preference signaling on orthopaedic surgery applicant experiences and outcomes in the 2023 residency application cycle and match. An anonymous electronically based survey study developed using Research Electronic Data Capture (REDCap) was send to 895 applicants to a single orthopedic residency program. 148 applicants filled out some portion of the survey for a 16.5% response rate. Results: 51% of applicants applied to 61-100 programs. Applicants received more interview offers from programs they signaled compared to programs they did not signal. 50% of applicants responded that the number of allotted signals was "just right", with more applicants responding that the number of signals allotted was "too many" rather than "too few". 62% of applicants agreed that signaling increased his/her chances of receiving an interview offer at a signaled program, 66% were satisfied with the results of the match, and 50% thought signaling had a positive impact on the application process. Conclusion: Overall, preference signaling was well received by applicants and may help to connect applicants with residency programs they are specifically interested in. Level of Evidence: III.

Foreword: U.S. Marine Gender Integration in Recruit Training.

The 2020 National Defense Authorization Act mandated that the Marine Corps not segregate recruit training by gender. This Military Medicine supplement details an independent academic study contracted by the Marine Corps Training and Education Command to inform the Marine Corps' future approaches to gender integration at recruit training. The authors conclude that with proper science-based training and an intentional approach to gender integration, the Marine Corps can bolster gender integration without losing its traditions, high standards, or warrior ethos in recruit training. A feasible path lies ahead to enhance the Corps' legacy of success. This special issue supports the Marine Corps Training and Education Command 2030 posture statement for leveraging science and technology for policy and doctrine to prepare and modernize the Marine Corps for the future operating environment.

Recruit Profiles Across the U.S. Armed Forces: Implications for Increasing Gender Integration in Recruit Training.

INTRODUCTION: This article uses recent survey data from a study on gender integration at recruit training across the U.S. Armed Forces to examine service, gender, and training differences in recruit's gender attitudes, beliefs, and cohesion metrics. In addition to providing a descriptive understanding of our recruit sample, this article examines factors germane to gender integration at recruit training such as gender attitudes, sexist beliefs, and unit cohesion. MATERIALS AND METHODS: This article uses data from a survey of U.S. Marine Corps (USMC), U.S. Army, U.S. Air Force, U.S. Navy, and U.S. Coast Guard recruits as part of a USMC-commissioned study to develop alternate models and recommendations for increasing gender integration in USMC recruit training. At all sites but the USMC, recruits completed the survey 1 to 2 weeks before graduation. At the Marine Corps Recruit Depots, recruits participated in the survey at the beginning (week 2) and end (week 11) of their 13-week training cycle. A 19-question survey captured sociodemographic information, perspectives and experiences during recruit training, and gender attitudes and beliefs. Analyses were conducted on the sample with complete data on the measures reported, including those USMC recruits observed at both week 2 and week 11 (n = 629). Descriptive statistics (percentage) were calculated for all categorical outcome variables. Outcome variables (cohesion, gender, and sexism attitudes) were compared between groups using chi-squared tests or Fisher's exact tests, as appropriate. RESULTS: Recruits differed significantly across services in perceptions of unit cohesion on 3 of the 4 indicators: Platoon members are cooperative, know they can depend on each other, and really respect each other (P < .05). These differences appear to be driven by female recruit difference across service. They reported significant differences in gender role attitudes across the services, with USMC recruits being most likely to endorse traditional gender roles compared to other service recruits. Male USMC recruits were significantly more likely than their female peers to agree that men should achieve outside the home and women should take care of the home and family (21.3% versus 6.3%, P < .05). The only statistical differences in attitudes about equality of treatment and opportunity among recruits were between male and female USMC recruits. All items capturing sexist attitudes elicited statistically significant differences between male USMC recruits and male recruits in other services (P < .05). There were significant differences in all sexism measures between male and female USMC recruits (P < .05). There is a significant decline in some sexist attitudes between weeks 2 and 11 of training among male USMC recruits (P < .05). Nearly one-half to three-fourths of male USMC recruits hold sexist attitudes, even near the end of recruit training. CONCLUSIONS: The disparate gender and sexism attitudes of male USMC recruits compared with their peers in other services, and their fellow female USMC recruits suggest efforts to increase gender integration at entry-level training are needed, but also may be challenging since male USMC recruits report the highest levels of sexist attitudes among all recruits.

Recruit Perspectives on Gender Integration at Recruit Training: A Comparison by Service and Gender.

INTRODUCTION: Recruit training is the initial entry for enlisted personnel in the military. The Services execute gender-integrated recruit training differently. The U.S. Marine Corps (USMC) maintains same-gender platoons led by same-gender drill instructors in integrated companies; further integration occurs at select training events. The other Services train recruits in gender-integrated units with mixed-gender drill instructor teams. We examine recruits' experiences and perceptions of gender integration at recruit training, their desired level of integration, and preferences for increasing gender integration, comparing by Service and gender. MATERIALS AND METHODS: Recruit perspectives and experiences were captured in a 19-question survey (n = 632) and 90-min focus groups (n = 260) near graduation from recruit training. Data were collected from June to November 2021. Because of the Coronavirus disease (COVID-19) pandemic restrictions, the Navy and Air Force were not conducting gender-integrated recruit training during data collection. Outcome variables were compared cross-Service by gender and within Service by gender using chi-squared tests or Fisher's exact tests, as appropriate; focus group data were analyzed using initial and secondary coding schemes. Three USMC training models, varied by level of integration, were also analyzed (Male-Only, Series Track, and Integrated Company). RESULTS: Significant gender differences across and within Service emerged in recruits' experience being trained by an opposite-gender instructor. Male recruits had significant differences by Service (P < .001), and USMC female recruits reported being trained by male instructors more than their male peers by female instructors (Series Track P = .002; Integrated Company P < .001). In the focus groups, recruits described common differences with how men and women embodied being a drill instructor. Significant gender differences across (both male and female P < .001) and within Service were reported for closeness of training with opposite-gender peers (Air Force P = .028; U.S. Marine Corps (USMC) Integrated Company P = .010; Army P = .048), an expected finding given varied integration during data collection. Male and female recruits had significant differences by Service in their preference for integration at the lowest unit level (both male and female P < .001), with those who experienced integrated training showing higher levels of endorsement. In the focus groups, recruits articulated benefits and challenges of gender-integrated recruit training. Significant gender differences across Service emerged in preferences for more integration in specific training activities. Within Service, female USMC Integrated Company recruits wanted more integration in tactical/field, physical fitness, and classroom training than their male peers (P < .001 for all). In the focus groups, USMC recruits of both genders desired more integrated training events, particularly those involving combat and tactical skill development. CONCLUSIONS: This study provided an opportunity to examine recruit perspectives on gender-integrated training. Services valuing opposite-gender instructor exposure in recruit training must ensure that male recruits are being taught and led by female instructors given disproportionate demographics. Recruits who experienced integrated training were more supportive of integration, indicating that this experience may increase their support for gender-integrated training units and environments. Today's recruits understand that they are entering gender-integrated working environments, and our results indicate that they expect recruit training to mirror that reality.

The Role of Drill Instructors and Gender Integration at Recruit Training: Examining Intersections of Gender and Integration in the Recruit Training Environment.

INTRODUCTION: Drill instructors (DIs) are responsible for executing their Services' recruit training programs and for training recruits. DIs assume a variety of roles, including teaching and developing practical skills and knowledge, mentoring, modeling appropriate behavior and attitudes, motivating recruits for success during and after recruit training, applying and instilling discipline, and ensuring the safety and welfare of recruits. This article examines two major research questions at the intersection of gender, gender-integrated training, and the DI role: (1) What differences exist in how DIs experience their role by gender? and (2) how does gender-integrated recruit training affect DIs' approach to training? MATERIALS AND METHODS: This article draws from 87 semistructured interviews conducted with Service leaders, training cadre, and DIs in service of a broader Marine Corps interdisciplinary study on gender integration at recruit training. Interviews were conducted virtually and in-person with Marine Corps, Army, Navy, Air Force, and Coast Guard personnel from June to November 2021. Each interview was coded with initial and secondary codes developed through a flexible coding approach. Data were analyzed across and within relevant categories such as gender and Service to identify themes and patterns. RESULTS: Although the DI role was universally described as demanding and difficult, unique challenges for women consistently emerged from the data. The top reported challenges faced by female DIs were personnel shortages, work and family conflict, culture-driven sexism in the training environment from male peers and recruits, and pressure to excel above and beyond their male peers. In recruit training, DIs are responsible for executing gender-integrated practices. Service leaders, training cadre, and DIs described how gender integration practices affect their approach to the role and implementation of training, including addressing and dismantling sexism, shutting down recruit romantic relationships, training all recruits in an equal manner, knowing gender-specific grooming standards, increasing communication among DIs, and working with mixed-gender DI teams. CONCLUSIONS: Female DIs face additional challenges in and outside the role compared with their male peers, and some of these challenges are preventable. Staffing and personnel issues plague the female DI population and are a persistent and pervasive challenge to gender integration efforts. Women are a necessary and highly desirable population to fill the DI role, particularly as Services aim to expose recruits to leaders of both genders during their critical first training experience. DIs play an important role in ensuring the successful completion of recruit training, ultimately helping to build the future leaders of the military. The success of gender integration efforts depends on DIs' intentional approach to the process. Future research can build on this work by expanding the scope to other military training environments (beyond recruit training) and examining how DIs' own sociodemographic positions (e.g., gender, race, ethnicity, and sexual orientation) inform their perspective on and approach to equity in the training environment.

Design Considerations for a Multidisciplinary Approach to Provide Policy Recommendations on Gender-Integrated Recruit Training in the Marine Corps.

INTRODUCTION: Recruit training is designed to transform civilians into physically fit military service members, who embody their service's core values and possess military discipline and skills. At the time this research began, the U.S. Marine Corps (USMC) remained the only service that segregated recruits by gender at the lowest unit level (e.g., platoon) and employed gender-segregated drill instructor teams. USMC's Marine Corps Recruit Depots (MCRD) must comply with a 2020 Congressional Mandate to not segregate training by gender in Parris Island by 2025 and San Diego by 2028. In turn, USMC requested an independent scientific study to analyze current approaches to gender integration at recruit training to propose alternate models and other policy recommendations that increase gender integration while maintaining current USMC standards. The Marine Corps is currently evaluating alternate models and recommendations to optimize entry-level training. This article outlines considerations for choosing the optimal research study design, research methods, and types of data collected in a study intended to provide policy recommendations on gender-integrated recruit training for the USMC. MATERIALS AND METHODS: Research data were collected during visits to the MCRDs and selected recruit training locations for the Army, Air Force, Navy, and Coast Guard. Data collection on USMC recruits from three cohorts involved social science assessments (focus groups and surveys) and human performance testing (countermovement jumps and isometric mid-thigh pulls, sleep and activity wearables, and cortisol data) at multiple points in the training cycle. Data on recruits from the sister services were limited to social science assessments. Approximately 600 recruits between the two MCRDs and 160 recruits from the sister services participated in the study during a 7-month timeframe in 2021. The research team conducted extensive ethnographic observations of recruit training at all selected research sites and interviewed training cadre, drill instructors, and service leadership responsible for recruit training (∼90 interviews). Additionally, the research team interviewed 20 experts on gender integration or recruit training who possessed alternate viewpoints from the current USMC practice. RESULTS: The mixed methods study was designed to assess the current gender integration practices at recruit training across the services to generate alternative models of gender integration for USMC. The research team developed a set of multidisciplinary objectives and research questions serving as the foundation of the research study design and data collection process. The study was designed to collect qualitative, quantitative, and administrative data informed by social science and human performance disciplines. To ensure that all aspects and implications relevant to gender integration were considered, select data were collected across services and with stakeholders at all levels. CONCLUSIONS: This multidisciplinary research approach provided a comprehensive picture of the current USMC recruit training models. The research team captured multiple perspectives and data points for analysis through an expansive view on gender integration across all services, by interacting with participants at all levels of the institutions in varied ways. The information and data gathered enabled the research team to establish objective, data-driven alternate models, and recommendations for enhancing gender integration at recruit training for the USMC.

Increasing Gender Integration in U.S. Marine Corps Recruit Training: Policy Recommendations and Rationales From an Interdisciplinary Study.

INTRODUCTION: This article describes alternate models and policy recommendations created by an interdisciplinary team of researchers to increase gender integration at U.S. Marine Corps (USMC) recruit training. The USMC requested a study to analyze current approaches to gender integration at recruit training and provide alternate models that maximize integration, while continuing to train marines to established standards. USMC remains the only service that segregates recruits by gender at the lowest unit level (e.g., platoon) in recruit training and maintains gender-segregated drill instructor teams (i.e., same-gender teams train platoons of same-gender recruits). MATERIALS AND METHODS: A mixed-method, interdisciplinary approach was used to capture multiple perspectives and informed recommendations and alternate models for gender integration. The team studied select USMC, army, navy, air force, and coast guard recruit training locations, between June and November 2021. At each site, the team collected qualitative, quantitative, and administrative data as well as physical performance metrics and human performance outcomes. Study participants included recruits, drill instructors, training cadre, service leaders, and subject matter experts on gender integration in military services. Each alternate model was designed to maximize the feasibility of implementation within current USMC training conditions. RESULTS: The research team developed three alternate models and several policy recommendations. Alternate model 1 proposed a methodology for mixed-gender drill instructor teams within the Integrated Company model, USMC's current integrated training model. Alternate model 2 proposed an Integrated Company Plus model which increases the number and types of gender-integrated training events at or below the platoon level within the Integrated Company model. Alternate model 3 outlined an integrated platoon model where recruits fall out into integrated training platoons after their morning routine, with two options of varying integration based on USMC priorities for integration. The team also proposed a set of policy recommendations independent of the three alternate models to support current and future gender integration efforts at the Marine Corps Recruit Depots. CONCLUSIONS: Gender-integrated military training has been shown to positively alter perceptions and evaluations of women in military settings over detrimental aspects developed by gender-segregated training. The study team recommended USMC train recruits in the Integrated Company model with mixed-gender drill instructor teams (alternate model 1) and integrate more training events following the priority tiers outlined in the Integrated Company plus model (alternate model 2). The combined execution of these two alternate models would provide USMC recruits increased exposure to direct, sustained training from opposite-gender drill instructors and deliver intentional training opportunities for male and female recruits to work together and interact in meaningful ways. The integrated platoon model (alternate model 3) would offer USMC recruits the most direct exposure to training and working with members of the opposite gender, but it requires substantial changes to current logistics, accountability, and training procedures.

Selection of international medical graduates into postgraduate training positions in Canada. Who applies? Who is selected?

Background: International medical graduates (IMGs) are an essential part of the Canadian physician workforce. Considering current pressures on the health care system, an update regarding application numbers and match rates for IMGs to postgraduate positions in Canada is needed. Methods: We conducted a quantitative cross-sectional study to explore the characteristics of IMGs who are currently applying to the Canadian Residency Matching Service (CaRMS) positions to gain a broad understanding of the composition of this group and the factors associated with successful matching. Results: Out of 1,725 applicants in 2019, 14.1% matched on the first attempt and 6.4% after two to three attempts. Only 22.7% matched with a position (57.6% women). Applicants submitted an average 19.6 site/program applications. The percentage of IMGs matched did not statistically differ by gender. The relationship between the year of graduation or geographic area of medical school qualified and matching was significant for the first and second iterations, with current-year graduates and Oceania/Pacific Islands applicants more likely to match. Conclusions: This study provided us with accurate numbers and information about the Canadians studying abroad and IMG groups applying, and factors associated with being matched to the IMG positions through CaRMS, which will be instrumental in informing future selection implications for Canada.

Contexte: Les diplômés hors du Canada et des États-Unis (DHCEU) constituent un élément essentiel de la main-d'œuvre médicale au Canada. Compte tenu des pressions qui s'exercent actuellement sur le système de santé, il est nécessaire de faire le point sur le nombre de candidatures et les taux de jumelage des DHCEU à des postes de résidence au Canada. Méthodes: Nous avons mené une étude quantitative transversale pour explorer les caractéristiques des DHCEU qui postulent actuellement aux postes du Service canadien de jumelage des résidents (CaRMS) afin de mieux comprendre la composition de ce groupe et les facteurs associés à un jumelage réussi. Résultats: Sur 1 725 candidats en 2019, 14,1 % ont été jumelés dès leur première tentative et 6,4 % après 2 ou 3 tentatives. Seulement 22,7 % des candidats ont obtenu un poste (57,6 % de femmes). En moyenne, les candidats ont soumis des demandes à 19,6 endroits/programmes. Le pourcentage de DHCEU jumelés n'était pas statistiquement différent selon le sexe. La relation entre l'année d'obtention du diplôme ou la zone géographique de la faculté de médecine où il avait été obtenu et le jumelage était significative pour le premier et le deuxième tours, les diplômés de l'année en cours et les candidats de l'Océanie/îles du Pacifique étant plus susceptibles d'être jumelés. Conclusions: Cette étude nous a fourni des chiffres et des renseignements précis sur les Canadiens qui étudient à l'étranger et les groupes de DHCEU qui posent leur candidature aux postes destinés aux DHCEU dans le cadre du CaRMS, ainsi que sur les facteurs associés à un jumelage réussi, ce qui contribuera à guider la sélection des futurs candidats au Canada.

When Money Is Not Enough: Reimagining Public Health Requires Systematic Solutions To Hiring Barriers.

Public health departments in the US have experienced workforce shortages and challenges in recruiting new employees for decades. Reimagining the public health system will require sufficiently staffed health departments. This Commentary summarizes what is known about the issues that state and local health departments face during the hiring process, with a focus on civil service and merit-based hiring barriers. Although health departments have recently received funding to recruit new employees, they still struggle to hire them. Recommendations for change include tracking hiring process metrics; implementing formal quality improvement to strategically resolve delays; developing formal pathways for converting fellows, interns, and contractors into staff positions; and initiating workarounds in the short term and legal changes to hiring rules as necessary and feasible.

Resident Recruitment in a New Era.

ABSTRACT: This chapter focuses on resident recruitment and recent US National Resident Matching Program changes and the impact in the evaluation and ranking of applicants within the specialty of anesthesiology. Recruitment challenges are examined as well as program strategies and potential future directions. Also discussed are DEI initiatives within the recruitment process.

Should my recommendation letter be written by artificial intelligence?

SummaryLetters of recommendation are increasingly important for the residency match. We assessed whether an artificial intelligence (AI) tool could help in writing letters of recommendation by analyzing recommendation letters written by 3 academic staff and AI duplicate versions for 13 applicants. The preferred letters were selected by 3 blinded orthopedic program directors based on a pre-determined set of criteria. The first orthopedic program director selected the AI letter for 31% of applicants, and the 2 remaining program directors selected the AI letter for 38% of applicants, with the staff-written versions selected more often by all of the program directors (p < 0.05). The first program director recognized only 15% of the AI-written letters, the second was able to identify 92%, and the third director identified 77% of AI-written letters (p < 0.05).

Recruitment and retention of rural allied health professionals: a scoping review.

INTRODUCTION: The purpose of this study was to understand what literature exists to comprehend demographics and predicted trends of rural allied health professionals (AHPs), person factors of rural AHPs, and recruitment and retention of rural AHPs. METHODS: A scoping review was completed and reported using the Preferred Reporting Items for Systematic Reviews and Meta-Analyses Extension for Scoping Reviews. Articles were analyzed using three a priori categories of recruitment and retention, person factors, and demographics and trends. RESULTS: Eighty articles met inclusion criteria for the review. Most of the literature came from Australia. Most research studies were qualitative or descriptive. A priori coding of the articles revealed overlap of the a priori codes across articles; however, the majority of articles related to recruitment and retention followed by demographics and trends and person factors. Recruitment and retention articles focused on strategies prior to education, during education, and recruitment and retention, with the highest number of articles focused on retention. Overall, there were no specific best strategies. Demographic data most commonly gathered were age, practice location, profession, sex, gender, previous rural placement and number of years in practice. While person factors were not as commonly written about, psychosocial factors of rural AHPs were most commonly discussed, including desire to care for others, appreciation of feeling needed, connectedness to team and community and enjoyment of the rural lifestyle. CONCLUSION: The evidence available provides an understanding of what research exists to understand recruitment and retention of AHPs from a recruitment and retention approach, person factor approach, and demographics and trends approach. Based on this scoping review, there is not a clear road map for predicting or maintaining AHPs in a rural workforce. Further research is needed to support increased recruitment and retention of AHPs in rural areas.

Exploring barriers to care home research recruitment during the COVID-19 pandemic: The influence of social media recruitment posts and public sentiment.

INTRODUCTION: Recruitment of care home staff to research studies is recognised as challenging. This was further exacerbated by the COVID-19 pandemic and the associated negative media portrayal of care home workers. Social media use has surged since the onset of COVID-19 lockdowns, offering a plausible approach to understanding the barriers to care home research recruitment and gaining insight into public perceptions of care home workers. AIM: To utilise comments from two Facebook recruitment posts to: 1) gain an understanding of potential barriers to recruitment of healthcare workers (HCWs) in UK care homes, and 2) explore public sentiment towards care home research and care homes in the context of the COVID-19 pandemic. METHODS: This cross-sectional study analysed comments from two Facebook posts (available June-October 2021) advertising a separate study on psychological support for care staff during the pandemic. This study was situated within a larger investigation into the mental health and wellbeing of care home staff and employed both qualitative analysis and quantitative methods (word count and correlations between words used and between posts). RESULTS: Three themes were identified from the qualitative analysis: support, mistrust and blame. There was a greater use of words associated with support and negative emotive words in post 2. Post 2 comments featured significantly more choice words and first-person singular pronouns than post 1 which indicated a resentful sentiment from those who advocate freedom of choice and control. Discussion of mistrust towards researchers was most prominent in post 1 indicating the importance of relationship building between researchers and HCWs in UK care homes. With attribution to blame, there was a larger range of negative emotion words than positive emotion words. DISCUSSION AND CONCLUSION: Taken together our findings offer novel insights into why recruitment to care home research during the pandemic including the use of social media might be problematic. Social media is a useful tool for recruitment but should not be considered as a one-time input. Researchers should pro-actively engage with the study population from the start using co-design with resident and public groups to support recruitment and ensure these populations are accurately represented within research.

The allied health rural generalist pathway: a cost consequence analysis.

INTRODUCTION: Rural and remote health workforces face longstanding challenges in Australia. Little is known about the economic effectiveness of workforce initiatives to increase recruitment and retention. A two-level allied health rural generalist pathway was introduced as a workforce strategy in regional local health networks (LHNs) in South Australia in 2019. This research measured the resources and outcomes of the pathway following its introduction. METHODS: A multi-phase, mixed-methods study was conducted with a 3-year follow-up period (2019-2022). A cost-consequence analysis was conducted as part of this study. Resources measured included tuition, time for quarantined study, supervision and support, and program manager salary. Outcomes measured included length of tenure, turnover data, career progression, service development time, confidence and competence. RESULTS: Fifteen allied health professional trainees participated in the pathway between 2019 and 2022 and seven completed during this time. Trainees participated for between 3 and 42 months. The average total cost of supporting a level 1 trainee was $34,875 and level 2 was $70,469. The total return on investment within the evaluation period was $317,610 for the level 1 program and $58,680 for the level 2 program. All seven completing trainees continued to work in regional LHNs at the 6-month follow-up phase and confidence and competence to work as a rural generalist increased. CONCLUSION: This research found that the allied health rural generalist pathway has the potential to generate multiple positive outcomes for a relatively small investment and is therefore likely to be a cost-effective workforce initiative.

Hawks and Doves in Standardized Letters of Evaluation: 6 Years of Rating Distributions and Trends in Emergency Medicine.

Background Standardized Letters of Evaluation (SLOEs) are an important part of resident selection in many specialties. Often written by a group, such letters may ask writers to rate applicants in different domains. Prior studies have noted inflated ratings; however, the degree to which individual institutions are "doves" (higher rating) or "hawks" (lower rating) is unclear. Objective To characterize institutional SLOE rating distributions to inform readers and developers regarding potential threats to validity from disparate rating practices. Methods Data from emergency medicine (EM) SLOEs between 2016 and 2021 were obtained from a national database. SLOEs from institutions with at least 10 letters per year in all years were included. Ratings on one element of the SLOE-the "global assessment of performance" item (Top 10%, Top Third, Middle Third, and Lower Third)-were analyzed numerically and stratified by predefined criteria for grading patterns (Extreme Dove, Dove, Neutral, Hawk, Extreme Hawk) and adherence to established guidelines (Very High, High, Neutral, Low, Very Low). Results Of 40 286 SLOEs, 20 407 met inclusion criteria. Thirty-five to 50% of institutions displayed Neutral grading patterns across study years, with most other institutional patterns rated as Dove or Extreme Dove. Adherence to guidelines was mixed and fewer than half of institutions had Very High or High adherence each year. Most institutions underutilize the Lower Third rating. Conclusions Despite explicit guidelines for the distribution of global assessment ratings in the EM SLOE, there is high variability in institutional rating practices.

Perceptions and Bias of Small Business Leaders in Employing People with Different Types of Disabilities.

PURPOSE: Despite existing employment-related legislation and governmental programs, people with disabilities continue to face significant barriers to competitive employment. These obstacles are partially due to biases among employers regarding the contributions of people with disabilities and perceptions about accommodation costs, which can affect their hiring decisions. Existing research on employment barriers and facilitators often treats people with disabilities homogenously and focuses mainly on large companies. This study helps to fill these gaps by exploring the motivations and challenges small employers face when hiring people with disabilities and how their attitudes and willingness to hire vary based on disability type. METHODS: We surveyed business owners and decision-makers at companies with fewer than 100 employees resulting in a sample of 393 company respondents. Through descriptive analyses, we examined variations in respondents' willingness to hire and the prevailing attitudes among the company leaders sampled. We explored how employer attitudes can either hinder or support the hiring of people with disabilities. We conducted multivariate analysis to explore the connections among attitudinal barriers, facilitators, and willingness to hire individuals with various disabilities, reflecting disability's heterogeneous nature. RESULTS: Our findings reveal that, in terms of hiring people with disabilities, the most important concerns among employers are: inability to discipline, being unfamiliar with how to hire and accommodate, and uncertainty over accommodation costs. These concerns do not differ between employers covered by the Americans with Disabilities Act (ADA) and non-covered employers. However, ADA-coverage may make a difference as ADA-covered employers are more likely to say they would hire an applicant with a disability. We find that for small companies (less than 15 employees), the positive effect of the facilitators (positive perceptions about workers with disabilities) almost completely offsets the negative effect of the barriers. However, for the larger companies, the marginal effect for an additional barrier is significantly more predictive than for an additional facilitator. Among the disabilities we examined, employers are least likely to hire someone with blindness, followed by mental health disabilities, intellectual disabilities, deafness, and physical disabilities, underscoring that employers do not view all types of disabilities as equally desirable at work. CONCLUSIONS: Understanding small employers' underlying concerns and effectively addressing those factors is crucial for developing effective intervention strategies to encourage small employers to hire and retain people with different disabilities. Our results suggest greater openness among ADA-covered employers to hiring people with disabilities, but the perceived barriers indicate a need for ongoing information on effective intervention strategies to increase disability hiring among all small employers.

Recruiting and cultivating future leaders in laboratory science.

PURPOSE OF REVIEW: Technological in-vitro fertilization (IVF) advancements originate in the embryology laboratory, and are accompanied by increased regulatory oversight and risk management. Stakes have never been higher or the need greater for the recruitment and cultivation of leaders in laboratory science to navigate the direction of IVF. Current thought leaders in state-of-the-art laboratories must prioritize this mission to optimize and preserve the future of IVF. RECENT FINDINGS: Leaders in laboratory science must be able to speak to patients, the lay public, business leaders, scientific colleagues and clinical embryologists. While technically gifted, laboratory leaders may benefit from leadership training. Recruitment of scientists into IVF is currently challenging due to a lack of branding and no clear pipeline for new scientists to enter the field. Once recruited however, cultivation of new leaders requires coaching and skill acquisition over time, in order to create multifaceted laboratory leadership. SUMMARY: Laboratory leaders are typically recruited based on education and experience to lead teams of embryologists. These leaders will adopt new technologies in the laboratory. Therefore, laboratory leaders play a powerful role in IVF requiring leadership skills ultimately driving patient outcomes. These laboratory directors must possess innate leadership abilities or learn how to lead their teams.