Female Clinicians Research Articles

Mindfulness Exercises Reduce Acute Physiologic Stress Among Female Clinicians.

Approximately 50% of clinicians experience excessive emotional, physical, and mental stress, with repercussions across the entire medical system. Mindfulness exercises may mitigate this excessive stress. Heart rate variability (HRV) is an objective stress measure that can quantify which mindfulness exercises provide the greatest stress reduction. To define the impact of specific mindfulness exercises on HRV, a surrogate for physiologic stress, and the relationship between physiologic (HRV) and subjective stress measured by the State-Trait Anxiety Inventory during a one-day mindfulness workshop. This was a prospective observational pilot study performed at a quaternary children's hospital with diverse subspecialists of pediatric nurses, nurse practitioners, and physicians. Our primary outcome measure was change in HRV from baseline during three mindfulness exercises. The grounding, deep breathing, and body scan exercises all produced statistically significant changes in HRV among our 13 female participants. The body scan exercise produced statistically significant changes in all studied HRV parameters compared with baseline. We observed significant increases in Root Mean Square of Successive Differences between normal heartbeats (p = 0.026), high frequency (p ≤ 0.001), and the parasympathetic nervous system index (p ≤ 0.001) reflecting increased parasympathetic tone (e.g., relaxation), whereas sd 2/sd 1 ratio (p ≤ 0.001) and the stress index (p = 0.004) were decreased reflecting sympathetic withdrawal (e.g., decreased stress). Subjective stress decreased after 1-day mindfulness training (44.6 to 27.2) (p < 0.001). Individuals with the largest decrease in subjective stress also had the most improvement in HRV during the body scan exercise. Clinician stress levels (HRV) improved after participating in grounding, deep breathing, and body scan meditations, which may highlight their importance as stress reduction tools for clinicians. Monitoring of HRV during mindfulness exercises may provide deeper understanding of which specific exercises produce the greatest physiologic stress reduction for individual participants and the trend of these changes over time.

A-183 Examination of the Roles and Responsibilities of Clinical Chemists as Determined by an International Peer Response-Based Survey

Abstract Background Doctoral-level clinical chemists (also termed clinical biochemists) have unique, broad roles in laboratory medicine spanning numerous clinical specialties. However, the full scope of responsibilities for a clinical chemist is not well understood, and institutional recognition and support varies. We sought to better understand the roles and responsibilities of practicing clinical chemists through distribution of an online survey designed to examine work-related responsibilities and other key factors related to job satisfaction. Survey results demonstrate the value of clinical chemists and can be used to promote parity within the profession. Methods Survey data was collected for 5 weeks from 10/10/2022-11/14/2022. The survey was targeted towards individuals holding doctoral level degrees (MD, PhD or MD/PhD), and consisted of 41 questions related to demographics, compensation, duties/responsibilities, and institutional support. Data analysis focused on responses from full-time clinical chemists located in the US and Canada (n=223/298 total respondents). Results Survey responses included male (n=109) and female (n=109) clinicians from all career stages (early &amp;lt;10y, n=101; mid 10-20y, n=63; late &amp;gt;20y, n=59). Clinical chemistry was the primary specialty reported (69%), followed by clinical pathology (16%), with 55% of responses reporting more than one specialty of practice, most often toxicology (21%). Multiple institution types (academic, community, reference laboratory, other) and academic career tracks (clinical, education, research, other) were represented; Most respondents were based in an academic hospital laboratory (n=131/223). Self-reported daily working hours varied by gender, years in practice, job duties and institutional setting; Females reported working more hours than males, working hours increased with years in practice, and the academic hospital setting reported the longest working hours, as did those on an ‘Education’ track. Responsibilities were quantified based on time spent per week; Clinical service represented the greatest time spent per week (majority result, 20-40h/week), followed by administrative (1-20h/week), research (&amp;lt;1-10h/week), teaching (&amp;lt;1-10h/week) and CE (&amp;lt;1-10h/week) duties. Support for clinical responsibilities was assessed further; 69% of respondents felt they had adequate time to perform clinical responsibilities, 55% reported access to adequate resources to perform clinical responsibilities and 51% reported feeling ‘Moderately’ or ‘Very’ stressed by clinical workload assignment. Top reasons for feeling overwhelmed included ‘Understaffing or inadequate support staff’ (n=113 responses), ‘Increased volume of work or caseload’ (n=73 responses) and ‘Lack of IT support to make necessary changes/improvements’ (n=70 responses). Resource quality was individually rated; Medical technologists, research technologists/scientists, LIS support and research support received a ‘Less than adequate’ rating by the majority of respondents, while compensation, administrative support and equipment received majority ‘Adequate’ ratings. Conclusions Clinical chemists work in a wide range of healthcare settings with unique career tracks, although the majority of work hours are devoted to provision of clinical service regardless of role definition. Most or all prioritize clinical work due to limited resources, which can limit research time and academic contributions. Clinical responsibilities are tied to feelings of stress and overwhelm in more than half of the survey population and could be reduced with improved quality and/or quantity of staff support.

B - 116 What Factors Predict Clinician Ratings of the Alliance in Neuropsychological Settings?

Abstract Objective The study aimed to identify variables associated with clinician ratings of the working alliance in neuropsychological assessment settings. Method The study utilized a cross-sectional design and survey method to evaluate hypotheses. Participants (n = 224) recruited from neuropsychology listservs were clinicians who saw an adult patient in the context of a neuropsychological evaluation within the past month. Clinician demographics, patient demographics, evaluation variables (e.g., time spent in evaluation, referral question, evaluation setting) and ratings of the salience of the alliance were collected via participant self-report. The Working Alliance Inventory – Neuropsychology Revised (WAI-NP-R) (α = 0.93) created for this study served as the primary outcome. Results Between-subjects ANOVA revealed that clinician-patient match on gender demographics was associated with higher clinician ratings of the working alliance (F(1, 218) = 6.73, p = 0.010, ηp2 = 0.03). Post hoc tests revealed that ratings of the working alliance were significantly higher for male clinicians with female patients (M = 104.26, SE = 2.54) than for female clinicians with female patients (M = 92.97, SE = 1.89), mean difference = 11.288, 95% CI [2.65, 19.92], p = 0.004. In a hierarchical regression analysis both examiner age (β = 0.297, p &amp;lt; 0.001) and examiner rating of importance of the alliance (β = 0.164, p = 0.010) were independent predictors of alliance ratings. Conclusions The study found that clinician ratings of the working alliance were associated with clinician age, gender, and investment in the alliance. Findings add to a limited but growing body of literature on the alliance within neuropsychology.

Basilar artery occlusion management: An international survey of gender influence on management.

The superiority of endovascular thrombectomy (EVT) over medical management was not established in two early basilar artery occlusion (BAO) randomized controlled trials. Despite this, many clinicians recommended EVT for acute BAO under certain circumstances. This paper aims to compare physicians' diagnostic and management strategies of BAO according to gender. From January to March 2022 an international survey was conducted regarding management strategies in acute BAO. We compared responses between clinicians by identifying gender. Questions were designed to examine clinical and imaging parameters influencing management of patients with BAO. Among the 1245 respondents from 73 countries, 311 (25.0%) identified as female. This figure was 13.6% amongst interventionists. Geographically, female respondents were lowest in Asia (14.5%) and North America (23.9%). The proportion of respondents identifying as female was consistent regardless of their years of experience. Female respondents were more likely to choose time of onset as time of first estimated stroke like symptom (48.0% vs. 38.5%, p < .01), were less likely to favor thrombectomy in the V4 segment of vertebrobasilar artery occlusions (31.5% vs. 43.3%, p < .01), and were less likely to find it acceptable to enroll all patients who met trial criteria in the standard medical treatment arm of a clinical trial (41.2% vs. 47.0%, p = .01). Male respondents were more likely to agree that thrombolysis would not alter their decision on proceeding with EVT (93.7% vs. 88.3%, p < .01). Female clinicians appear to be significantly underrepresented in stroke medicine. This is most pronounced amongst interventionists and in Asia. Although male and female opinions were closely aligned on many aspects of BAO management, differences in opinion were observed in a number of significant areas which influence decision making.

A Survey of Medication Diffusion and Attitudes Among Indian Clinicians Toward Pharmacotherapies for Alcohol Use Disorder

Introduction: Alcohol use disorder (AUD) is a significant cause of morbidity and mortality globally. However, uptake of AUD pharmacotherapies among clinicians has remained low. There exists a research gap regarding clinician attitudes and the diffusion of AUD pharmacotherapies among Indian clinicians. We conducted a survey to assess the same. Methods: An online survey was sent to clinicians nationwide from February and April 2023 to assess attitudes and practices regarding various AUD medications. Logistic and ordinal regression models evaluate the clinician and caseload factors determining medication diffusion and attitudes. Results: A total of 387 clinicians responded to our survey. Most of them were males (61.7%) and trained psychiatrists (56.3%). The diffusion for acamprosate, naltrexone, and disulfiram was 69.8%, 81.4%, and 58.2%, respectively. Baclofen had the highest diffusion. Female respondents had significantly lower perceived efficacy, acceptability, and safety for disulfiram. Independent practitioners were more likely to prescribe all pharmacotherapies except baclofen. Discussion: Diffusion for alcohol pharmacotherapies was incomplete. Baclofen had the highest diffusion, probably reflecting its cost and safety profile. Despite its perceived efficacy, safety concerns impacted the diffusion of disulfiram. Female clinicians had lower perceived attitudes toward disulfiram. Specific training for AUD pharmacotherapies is warranted for female clinicians and nonpsychiatrists.

Acceptability of 'as needed' biologic therapy in psoriasis: insights from a multistakeholder mixed-methods study.

Biologic therapies have led to increasing numbers of patients with psoriasis who have clear or nearly clear skin. It is current practice to continue biologic therapy indefinitely in these patients, which contributes to a substantial long-term drug and healthcare burden. 'As needed' biologic therapy in psoriasis may address this; however, our understanding of patient and clinician perceptions of this strategy is limited. The aim of this mixed-methods study was to gain insight into the perspectives of both patients and clinicians regarding the acceptability of an 'as needed' approach to biologic therapy in psoriasis, including potential barriers and enablers to implementation in routine care. We first conducted UK-wide online scoping surveys of patients with psoriasis and dermatology clinicians to explore their views on 'as needed' biologic therapy. Using topic guides informed by these survey findings, we then carried out qualitative focus groups with patients and clinicians. Themes were identified using reflexive thematic analysis. Of 67 patients and 27 clinicians completing the scoping surveys, 67% (43 of 64 patients) and 78% (21 of 27 clinicians) supported the use of 'as needed' biologic therapy, respectively. Respondents highlighted advantages such as a reduction in healthcare burden and greater ownership of care. Challenges included logistics of 'as needed' drug provision and potential risks of disease flare and drug immunogenicity. Focus groups comprised 15 patients with psoriasis [9 female patients (60%), average disease duration 32 years (range 9-64)] and 9 dermatology clinicians [8 female clinicians (89%), average dermatology experience 20 years (range 8-33)]. Both patients and clinicians felt that an 'as needed' treatment approach will deliver a reduction in treatment burden and present an opportunity for patient-led ownership of care. Both groups highlighted the importance of ensuring ongoing access to medication and discussing the potential impact of psoriasis recurrence. Patient preferences were influenced by their lived experiences, particularly previous difficulties with medication delivery logistics and establishing disease control. Clinician perspectives were informed by personal experience of their patients adapting their own dosing schedules. Clinicians highlighted the importance of targeted patient selection for an 'as needed' approach, ongoing disease monitoring, and prompt reaccess to medications upon psoriasis recurrence. These data indicate that 'as needed' biologic therapy in psoriasis is acceptable for both patients and clinicians. Formal assessment of clinical effectiveness and cost-effectiveness is warranted to enable the real-world potential of this approach to be realized.

The Female Emergency Medical Services Experience: A Mixed Methods Study

Background Emergency Medical Services (EMS) is a challenging profession. Little is known if there are gender differences in the experiences among EMS clinicians. Therefore, our aim was to understand and characterize the occupational experiences of female EMS clinicians. Methods A mixed methodological study was conducted among currently licensed female EMS clinicians via focus group and self-report survey data. Three focus groups (n = 5, 4, 13, respectively) were conducted with participants purposively recruited from primarily Northeastern EMS agencies. Through ongoing collaborations, a recruitment advertisement was provided to EMS leadership at respective agencies for distribution among their female staff. Sessions were recorded and transcribed for thematic analysis. A six-phase inductive analytical approach was utilized to evaluate focus group data. Qualitative findings were utilized to inform a cross-sectional, self-report survey consisting of occupational specific experiences, such as harassment and pregnancy, and validated measures of mental wellbeing. Descriptive statistics were used to describe the study sample and female EMS clinician occupational and personal experiences. Results A total of 22 female EMS clinicians participated across the three focus group sessions. Four major themes were identified: 1) the female EMS experience; 2) impact on personal wellbeing; 3) impact on occupational wellbeing; and 4) coping mechanisms. Each theme had multiple subthemes. There were 161 participants that attempted the 72-item survey, 13 partial and 148 competed surveys. Median age was 32 years (IQR: 25-42), and the majority were EMT-Bs (55.1%). Approximately 70.0% met the criteria for probable anxiety, 53.9% probable depression and 40.9% elevated symptoms of burnout. Almost 73.0% reported workplace harassment, with most experiences being perpetrated by patients and coworkers. Over 61.0% reported reconsideration of their career in EMS. Overall, survey data indicated interactions with peers and leadership, and social support were positive. Conclusions Findings highlight the need to improve the occupational experiences of female EMS clinicians to preserve and encourage the continuation of their participation in this workforce. Specifically tailored interventions aimed at protecting and improving their overall wellbeing are critical, particularly considering the increased occupational burden resulting from the pandemic. Future research should aim to understand specific predictors of adverse mental health outcomes among this population.

Being Essential and Feeling Expendable: Black Female Clinicians’ Narratives About Working in the U.S. During Dual Pandemics

&lt;i&gt;Historically and in the present day, Black women’s positionality in the U.S. has paradoxically situated them in a society where they are both intrinsically essential and treated as expendable. This positionality, known as gendered racism, manifests commonly in professional environments and results in myriad harms. In response, Black women have developed, honed, and practiced a range of coping styles to mitigate the insidious effects of gendered racism. While often effective in the short-term, these techniques frequently complicate Black women’s well-being. For Black female clinicians who experience gendered racism and work on the frontlines of community mental health, myriad bio-psycho-social-spiritual harms compound. This project provided an opportunity for Black female clinicians from across the U.S. to share their experiences during the dual pandemics of COVID-19 and anti-Black violence. I conducted in-depth interviews with clinicians (n=14) between the ages of 30 and 58. Using the Listening Guide voice-centered approach to data generation and analysis, I identified four voices to help answer this project’s central question: How do you experience being a Black female clinician in the U.S.? The voices of self, pride, vigilance, and mediating narrated the complex ways participants experienced their workplaces. This complexity seemed to be context-specific, depending on whether the clinicians worked in predominantly White workplaces (PWW), a mix of PWW and private practice, or private practice exclusively. Participants who worked only in PWW experienced the greatest stress, oppression, and burnout risk, while participants who worked exclusively in private practice reported more joy, more authenticity, and more job satisfaction. These findings have implications for mentoring, supporting, and retaining Black female clinicians.&lt;/i&gt;

Silent suffering: the impact of sexual health challenges on patient-clinician communication and adherence to adjuvant endocrine therapy among Black women with early-stage breast cancer.

Adjuvant endocrine therapy (AET) increases sexual health challenges for women with early-stage breast cancer. Black women are more likely than women of other racial/ethnic groups to report adverse symptoms and least likely to initiate and maintain AET. Little is known about how sexual health challenges influence patient-clinician communication and treatment adherence. This study explores facilitators of and barriers to patient-clinician communication about sexual health and how those factors might affect AET adherence among Black women with early-stage breast cancer. We conducted 32 semi-structured, in-depth interviews among Black women with early-stage breast cancer in the U.S. Mid-South region. Participants completed an online questionnaire prior to interviews. Data were analyzed using thematic analysis. Participants' median age was 59 (range 40-78 years, SD = 9.0). Adverse sexual symptoms hindered participants' AET adherence. Facilitators of patient-clinician communication about sexual health included female clinicians and peer support. Barriers included perceptions of male oncologists' disinterest in Black women's sexual health, perceptions of male oncologists' biased beliefs about sexual activity among older Black women, cultural norms of sexual silence among Southern Black women, and medical mistrust. Adverse sexual symptoms and poor patient-clinician communication about sexual health contribute to lower AET adherence among Black women with early-stage breast cancer. New interventions using peer support models and female clinicians trained to discuss sexual health could ameliorate communication barriers and improve treatment adherence. Black women with early-stage breast cancer in the U.S. Mid-South may require additional resources to address sociocultural and psychosocial implications of cancer survivorship to enable candid discussions with oncologists.

How exposure to patient narratives affects stereotyped choices of primary care clinicians.

In this paper, we examine whether patient narratives alter the impact of stereotyping on choice of primary care clinicians: in this case, the common presumption that female doctors will be more attentive to empathic relationships with patients. 1052 individuals were selected from a nationally representative Internet panel to participate in a survey experiment. Participants were given performance data about 12 fictitious primary care physicians, including a randomized set of narrative feedback from patients. We compared the choice of clinician made by participants who value bedside manner and were exposed to narratives in the experiment, compared to those valuing bedside manner who had not had this exposure. We estimated multivariate logistic regressions to assess whether exposure to patient comments that "disrupt" stereotypes influenced choice of physicians. Participants who saw patient comments and had previously reported caring about bedside manner had a 67% higher odds of choosing a female physician than those participants that did not see a patient comments, controlling for the content of the narratives themselves. When participants were exposed to patient comments that disrupt gendered stereotypes, they had a 40% lower odds of choosing a female physician. Simple exposure to patient narratives that do not clearly disrupt gendered stereotypes increased the likelihood of choosing a female clinician by priming attention to relational aspects of care. However, when the content of a sufficient proportion of patient comments runs counter stereotypes, even a minority of narratives is sufficient to disrupt gendered-expectations and alter choices.

Treatment patterns and clinician stress related to care of out-of-hospital cardiac arrest patients with a do not attempt resuscitation order

ObjectiveThis research investigated treatment patterns for out-of-hospital cardiac arrest patients with Do Not Attempt Resuscitation orders in Japanese emergency departments and the associated clinician stress. MethodsA cross-sectional survey was conducted at 9 hospitals in Okayama, Japan, targeting emergency department nurses and physicians. The questionnaire inquired about the last treated out-of-hospital cardiac arrest patient with a Do Not Attempt Resuscitation. We assessed emotional stress on a 0–10 scale and moral distress on a 1–5 scale among clinicians. ResultsOf 208 participants, 107 (51%) had treated an out-of-hospital cardiac arrest patient with a Do Not Attempt Resuscitation order in the past 6 months. Of these, 65 (61%) clinicians used a “slow code” due to perceived futility in resuscitation (42/65 [65%]), unwillingness to terminate resuscitation upon arrival (38/65 [59%]), and absence of family at the time of patient’s arrival (35/65 [54%]). Female clinicians had higher emotional stress (5 vs. 3; P = 0.007) and moral distress (3 vs. 2; P = 0.002) than males. Nurses faced more moral distress than physicians (3 vs. 2; P < 0.001). Adjusted logistic regression revealed that having performed a “slow code” (adjusted odds ratio, 5.09 [95% CI, 1.68–17.87]) and having greater ethical concerns about “slow code” (adjusted odds ratio, 0.35 [95% CI, 0.19–0.58]) were associated with high stress levels. ConclusionsThe prevalent use of “slow code” for out-of-hospital cardiac arrest patients with Do Not Attempt Resuscitation orders underscores the challenges in managing these patients in clinical practice.

Self-reported Patient-perpetrated Sexual Harassment and Subsequent Reporting Among Health Care Clinicians in Urology and Obstetrics-Gynecology: A Cohort Survey

To understand the experiences of urologists and obstetricians-gynecologists (obgyns) with patient-perpetrated sexual harassment (PPSH) since the clinical focus of these specialists may make them particularly vulnerable to PPSH. A multiple-choice anonymous online survey was administered in the Departments of Urology and Obgyn at a single institution from 22 September, 2022-18 October, 2022. The survey assessed if clinicians had experienced PPSH, including gender harassment, unwanted sexual attention, and/or sexual coercion from patients, where PPSH was witnessed or experienced, and whether implementation of chaperones impacted their experiences with PPSH. We conducted descriptive analysis by clinician sex, department, and form of PPSH experienced. We also performed logistic regression analysis to identify clinician factors associated with experiencing PPSH. Majority of respondents reported that they experienced or witnessed PPSH (78%, N=100). Gender harassment was the most common form of PPSH experienced by clinicians (53%, N=68). PPSH was most often experienced or witnessed in clinic (74%, N=70) and inpatient wards (66%, N=62). Of those who utilized chaperones, 80% (N=57) of clinicians reported they either did not reduce or were unsure if they reduced PPSH. When adjusting for clinician factors, being a female clinician (adjusted odd ratio [aOR]=5.1, 95% confidence interval (CI) 1.5-17.3), trainee (aOR=6.9, 95% CI 1.1-44.6), or a urologist (aOR=18.1, 95% CI 2.0-166.1) were associated with experiencing PPSH. Our study highlights the pervasiveness of PPSH among urologists and obgyns. Future studies should elucidate what policy changes can be effective in protecting clinicians from PPSH.

Exploring Muslim Women's Reproductive Health Needs and Preferences in the Emergency Department.

Objective: We explored individual Muslim women's reproductive healthcare experiences, preferences, beliefs, and behaviors in the emergency department (ED) and in general. Methods: This was a qualitative study conducted at a community ED using semi-structured interviews with a piloted interview guide. We interviewed participants awaiting care in the ED with the following criteria: female gender; English or Arabic speaking; aged ≥18years; and self-identified as Muslim. We conducted interviews in both English and Arabic until thematic saturation was reached. Transcripts were coded using an iteratively developed codebook, maintaining intercoder agreement greater than 80%. We used an inductive thematic analysis to identify themes, and results were interpreted in the context of interview language and patient's age. Results: We interviewed 26 Muslim-identified female ED patients. We found that cultural representation and sensitivity among ED staff mitigated discrimination and promoted inclusion for Muslim ED patients. However, assumptions about Muslim identity also impacted the participants' healthcare. Most participants endorsed a preference for a female clinician for their reproductive healthcare in general, but not necessarily for other areas of medicine. Clinician cultural concordance was not always preferred for participants in the ED due to fears about the loss of confidentiality. Marital status impacted beliefs about reproductive and sexual health in the context of Muslim identity. Overall, family planning was acceptable and encouraged in this patient population. Conclusion: The themes elucidated in this study may guide clinicians in developing culturally sensitive practices when providing reproductive healthcare to the Muslim population.

Which Information Matters? Using Policy Capturing to Understand Psychological Recommendations of Civil Competency

ABSTRACT Courts rely heavily on the recommendations of mental health evaluators when making decisions about competency (e.g., Zapf, Hubbard, Cooper, Wheeles, & Ronan, 2004), including civil competency (e.g., Quickel, Demakis, & Reeve, 2017); however, very little is known about how evaluators arrive at their opinions regarding an individual’s capacity. The current study assessed clinical decision-making using a policy capturing methodology. An ecologically valid sample (N = 47) of predominantly white (87.23%) and female (55.30%) clinicians who were eligible to conduct civil competency evaluations in North Carolina were recruited to examine the degree to which five key factors (functional test data, cognitive test data, personality test data, hospitalization history, and/or medication compliance) influenced clinician competency determinations. Personal insight into one’s decision-making process was also measured. Consistent with previous research, functional test data was weighted most heavily in evaluator decisions, though all five factors were considered. Further analysis suggested variable levels of self-awareness of one’s decision-making policies by participants depending on the factor. In addition, there was high agreement among clinicians when cases were straightforward, but perfect disagreement (half recommending competency, half recommending incompetency) among clinicians when cases were more complex. Implications for civil competency assessment and decision-making are discussed.

Assessment of clinician’s knowledge and attitude toward health extension program in Ethiopia: An exploratory factor analysis

Health extension workers (HEWs) are the primary implementers of the health extension program (HEP) &amp;ndash; a government-led community-based health-care program, but clinicians are anticipated to play a critical part in providing extensive support, thus, this study aimed to assess clinicians&amp;rsquo; knowledge and perceptions of HEP, a cross-sectional study was conducted with 1239 clinicians. A set of 54-item questions was created based on HEP guidelines and relevant literature. Exploratory factor analysis (EFA) identified latent variables with Eigenvalues matrix &gt;1. Cluster variables were derived through orthogonal varimax factor rotation, and internal reliability was evaluated using Cronbach&amp;rsquo;s alpha coefficient. A composite score was generated for each constructed factor, and the associations between variables were determined using a one-way analysis of variance. Multiple linear regression analysis was conducted to eliminate confounders, with statistical significance set at P &lt; 0.05. EFA provides three factors explaining 91% of the total variance and labeled as &amp;ldquo;clinician-perceived attitude towards the skill of HEWs&amp;rdquo; (F1), &amp;ldquo;clinician knowledge on HEP activities&amp;rdquo; (F2), and &amp;ldquo;clinician-perceived attitude towards the impact of HEP&amp;rdquo; (F3). Internal reliability for the 54 items was 0.96, and it was 0.93, 0.90, and 0.89 for F1, F2, and F3, respectively. 75.5% and 76.2% of clinicians had favorable attitudes toward F1 and F3, respectively, and 70.2% had good knowledge of F2. F1 was positively correlated with participation in HEP review meetings, home visits, HEP outreach, and willingness to work in HEP but negatively correlated with degree holders. F2 was positively correlated with participation in HEP review meetings, home visits, being married, and non-medical doctors but negatively correlated with willingness to work in HEP, older age, female, and degree holder clinicians. Three factors, focusing on knowledge, skill, and the impact of HEP, were found and fall under the second-generation HEP framework. Therefore, strengthening HEP guidelines is essential to ensuring the delivery of sustainable and pro-poor HEP.

Statue of Dr. Aletta Henriëtte Jacobs (1854-1929): Physician, Activist, and an Inspiration.

Dr Aletta Henriette Jacobs (9 February 1854 to 10 August 1929) was a Dutch physician and advocate of modern-day women's rights, being among the first female clinicians and to formally enrol at a Dutch university. She bolstered the Dutch and international women's movements and pioneered as the first woman to develop a clinic based on contraceptive principles in 1882 internationally. Her legacy has become paramount in the progression of modern-day feminism, where her vigour for equality and diversity has stipulated campaigns to demand women's voting rights, deregulate acts of prostitution, improve working conditions for women, and promote world peace through her work.

CLinician and patient characteristics effect on Antimicrobial Stewardship Interventions (CLASI) study.

To determine whether the gender of clinicians making antimicrobial stewardship recommendations has an impact on intervention acceptance rate. A retrospective, multivariable analysis of antimicrobial stewardship prospective audit and feedback outcomes. A multisite healthcare system including Mayo Clinic Rochester (MN), Mayo Clinic Arizona, Mayo Clinic Florida and 17 health-system hospital sites, where prospective audit and feedback is performed and documented within an electronic tool embedded in the medical record. The study included 143 Mayo Clinic clinicians (84 cisfemales and 59 cismales). Outcomes were analyzed from July 1, 2017, to June 30, 2022, for intervention rates, communication methods, and intervention acceptance by clinician gender, profession, patient age, and intensive care unit (ICU) status of patient. Of 81,927 rules, 71,729 rules met study inclusion. There were 18,175 (25%) rules associated with an intervention. Most of the rules were reviewed by pharmacists (86.2%) and stewardship staff (85.5%). Of 10,363 interventions with an outcome documented, 8,829 (85.2%) were accepted and 1,534 (14.8%) were rejected. Female clinicians had 6,782 (86.5%) of 7,843 interventions accepted, and male clinicians had 2,047 (81.2%) of 2,520 interventions accepted (P = .19). Female patients had more interventions than male patients (female vs male: 25.9% vs 24.9%; OR, 1.04; 95% CI, 1.02-1.08; P = .001). Patients in the ICU had a significantly lower intervention acceptance rate (ICU vs non-ICU: 78.2% vs 86.7%; OR, 0.56; 95% CI, 0.45-0.7; P < .001). Female and male clinicians were equally effective at prospective audit and feedback in a multisite antimicrobial stewardship program. Patients in the ICU were less likely to have stewardship interventions accepted.

Predictors of Better Shared Decision Making in Goals-Of-Care Clinician-Family Meetings for Critically Ill Neurologic Patients: A Multi-Center Mixed Methods Pilot Study (S4.003)

<h3>Objective:</h3> To characterize and quantify SDM in GOC meetings To identify factors associated with higher SDM score <h3>Background:</h3> Shared decision making (SDM) is recommended by experts to improve difficult decisions in ICUs; yet for the most difficult decision of all, the goals-of-care (GOC) decision, empirical research in medical-surgical ICUs demonstrated that only 2% of clinician-family meetings contained all SDM elements. Little is known about the extent and predictors of SDM in critically-ill neurological patients (CINPs). <h3>Design/Methods:</h3> Two qualitative coders applied a validated 10-element SDM instrument to 63 GOC clinician-family meetings for CINPs, audio-recorded at seven U.S. medical centers. Clinicians and families completed post-meeting questionnaires assessing their own prognostic estimates. We defined the Clinician-Family-Prognostic-Discordance-Score as the difference between both estimates and prognostic discordance as ≥20% difference. We applied univariate and multivariable longitudinal regression to identify predictors of more SDM. <h3>Results:</h3> The median SDM score (total number of unique SDM elements per meeting) was 7 (range 1–10; IQR 5–8). Only 6% of meetings contained all 10 SDM elements. The most common SDM elements were “<i>discussing uncertainty”</i>(89%) and <i>“assessing family understanding”</i>(86%); the least frequent elements were <i>“assessing the need for input from others”</i>(40%) and <i>“eliciting the context of the decision”</i>(32%). Prognostic discordance was 60% and 45% for hospital-survival and 6-month independent functioning, respectively. In univariate analyses, more SDM was associated with female clinicians, and Cohort 2. Meetings with less clinician-surrogate survival discordance approached significance. After adjustment, there was a trend towards clinician gender being an independent predictor of more SDM(p=0.11), but none of the variables were independent predictors. <h3>Conclusions:</h3> Few clinician-family GOC-meetings for CINPs contained all SDM elements. We uncovered modifiable gaps as opportunities for improvement. While our sample was too small to find independent predictors of SDM, our data supports the urgent need to continue our mixed-method of examination of clinician-family GOC-meetings in larger cohorts. <b>Disclosure:</b> Miss Fleming has nothing to disclose. Mr. Prasad has nothing to disclose. Ms. Ge has nothing to disclose. Mr. Meraj has nothing to disclose. Miss Franco has received personal compensation for serving as an employee of Umass Medical School. The institution of Catherine Hough has received research support from NIH. Bernard Lo has nothing to disclose. Shannon Carson has nothing to disclose. The institution of Jay Steingrub has received research support from NHLBI. Douglas White has received personal compensation in the range of $5,000-$9,999 for serving as an Editor, Associate Editor, or Editorial Advisory Board Member for uptodate. Douglas White has received personal compensation in the range of $5,000-$9,999 for serving as an Editor, Associate Editor, or Editorial Advisory Board Member for American Journal of Respiratory and Critical Care Medicine. The institution of Dr. Muehlschlegel has received research support from NIH. The institution of Dr. Muehlschlegel has received research support from NIH. The institution of an immediate family member of Dr. Muehlschlegel has received research support from NIH. Dr. Muehlschlegel has a non-compensated relationship as a Member of Board of Directors with Neurocritical Care Society that is relevant to AAN interests or activities.

Susan S. Smyth (1965-2022).

Susan S. Smyth (1965-2022).

Clinical Assessment of Residents: A Survey of Clinician Educators Regarding Resident Assessment Burden and Modifiable Factors.

A fundamental role of the clinician educator is to provide thoughtful assessments for resident development. A gap in the literature exists about whether the completion of assessments contributes to clinician educator burden. We sought to understand the degree to which completing resident assessments contributes to clinician educator burden, the drivers behind such perception, and whether modifiable factors exist. In October 2020, we conducted a cross-sectional study of adult hospital medicine clinician educators to explore burden associated with resident assessment. The authors developed a 10-item electronic survey (Likert type and sliding scale responses), asking about demographics, context, frequency and degree of burden, burdensome aspects of assessments, estimated time for assessments, and percentage of assessments turned in late or never. We conducted subgroup analyses for differences in responses based on sex and number of years practicing, and regression analyses for predictors of burden degree. Fifty of 81 (62%) surveyed faculty responded. Two percent (1 of 50) reported no burden, while 42% (21 of 50) reported infrequent ("never," "rarely," "sometimes") and 56% (28 of 50) reported frequent ("often," "always") burden. Of those experiencing burden, 67% (33 of 49) reported slight or moderate, and 33% (16 of 49) reported significant or extreme burden. Potentially modifiable causes included assessment request boluses, lag time between resident service and assessment requests, and technology involved. Female clinician educators estimated submitting a higher percentage of late assessments than males (65% vs 41%, P=.02). Number of years practicing was inversely associated with assessment time (β=-0.28, P=.01). Our findings suggest that resident assessments are a source of burden among adult hospital medicine clinician educators and that several potentially modifiable factors may underlie this burden.