Longitudinal Experience Research Articles

Virtual Resident Mentorship Groups for Fourth Year Medical Students Applying into Otolaryngology-Head and Neck Surgery.

To create a longitudinal near-peer mentorship program for medical students applying to otolaryngology. A program for longitudinal near-peer mentorship was designed based on a needs analysis of senior medical students. Program objectives were to (1) provide didactic education on common otolaryngology consults, (2) facilitate resident-student networking, and (3) enable applicants to meet other students. Senior otolaryngology residents were matched with medical students from across the United States applying to otolaryngology for a series of online small group meetings. Sessions included resident-designed didactics covering high-yield clinical scenarios and a mentorship component focused on transition to residency topics. Program evaluation included anonymized pre- and post-tests for each didactic session and an anonymous post-program participant survey. There were 40 student participants from across the United States, with an average attendance of 73% of sessions per participant. Performance on didactic testing improved for 2 of the 3 sessions. Participants stated they would be very likely to recommend each session to another student in the future (4.96/5.00, obs = 155). Participants stated the most valuable part of the program was interacting with residents (82% of responses), transition to residency advice (28%), and learning about otolaryngology consults (28%). Suggestions for improvement included expanding content, increasing the number of sessions, and involving additional faculty and residents. A longitudinal virtual experience can be valuable for near-peer mentorship for medical students applying to otolaryngology.

When loneliness dimensions drift apart: Emotional, social and physical loneliness during the COVID-19 lockdown and its associations with age, personality, stress and well-being.

Previous research differentiated between emotional loneliness (perceived lack of emotional connection with others) and social loneliness (perceived lack of a broader social network). We argue that physical loneliness (perceived lack of physical contact) constitutes a third dimension of loneliness that is particularly relevant in times of physical distancing. We conducted a longitudinal experience sampling study (N = 578) during the first 8 weeks of the COVID‐19 lockdown in Germany to test this claim. The results indicate that loneliness has a three‐dimensional structure encompassing emotional, social and physical loneliness. Each loneliness dimension explained a unique variance in perceived stress and psychological well‐being. However, the three loneliness dimensions differed in their prevalence during the contact restrictions and their associations with age and personality. Physical loneliness was higher during the contact restrictions whereas emotional and social loneliness remained on a normal level. Age was positively associated with social loneliness but negatively associated with physical loneliness. Extraversion was negatively associated with emotional and social loneliness but positively associated with physical loneliness. These findings expand loneliness models, enhance loneliness assessment and improve the prediction of vulnerability to loneliness.

The student perspective of a staff-student partnership scheme.

The student perspective of a staff-student partnership scheme.

Resource Document Calls for Improved Residency Training on SUDs

Resource Document Calls for Improved Residency Training on SUDs

ANEW Project to Develop and Support Rural Primary Practice

South Dakota is one of the nation’s most rural and frontier states and has the highest proportion of rural dwellers in the Midwest. Many of the state’s counties suffer from provider shortages, with nurse practitioners increasingly being called upon to fill the role of the primary care provider in clinics and critical access hospitals. However, family nurse practitioner (FNP) education programs are not required to provide the training and skills necessary to meet the unique challenges of rural practice.
 An Upper Midwest land grant university prepares both masters and doctoral FNP students to fill primary care provider needs in South Dakota and the surrounding region. The purpose and scope of this two-year Advanced Nursing Education Workforce (ANEW) project was to enhance an existing academic/practice partnership to prepare primary care advanced practice registered nursing (APRN) students for practice in rural and/or underserved settings in the state and region. The ANEW project provided FNP students with a longitudinal primary care clinical traineeship experience in rural clinical settings.
 Trainees benefited from traineeship funds, learning advanced procedures and skill concepts through attendance at a series of educational workshops, and job placement efforts postgraduation. The ANEW project also provided for a comprehensive preceptor development collaborative designed to enhance competence and confidence for independent rural practice and facilitate job placement in rural communities after graduation.
 This project strengthened the quality of FNP education through an academic/practice partnership which resulted in a symbiotic, synergistic relationship to address rural work force supply and the identification of the knowledge and skills needed for current and future rural healthcare providers.
 Keywords: family nurse practitioner, education, preceptor, academic, practice partnership, rural primary healthcare, healthcare provider shortage
 DOI: https://doi.org/10.14574/ojrnhc.v21i1.649

The role of perceived public and private green space in subjective health and wellbeing during and after the first peak of the COVID-19 outbreak

Research has consistently shown that access to parks and gardens is beneficial to people’s health and wellbeing. In this paper, we explore the role of both public and private green space in subjective health and wellbeing during and after the first peak of the COVID-19 outbreak that took place in the UK in the first half of 2020. It makes use of the longitudinal COVID-19 Public Experiences (COPE) study, with baseline data collected in March/April 2020 (during the first peak) and follow-up data collected in June/July 2020 (after the first peak) which included an optional module that asked respondents about their home and neighbourhood (n = 5,566). Regression analyses revealed that both perceived access to public green space (e.g. a park or woodland) and reported access to a private green space (a private garden) were associated with better subjective wellbeing and self-rated health. In line with the health compensation hypothesis for green space, private gardens had a greater protective effect where the nearest green space was perceived to be more than a 10-minute walk away. This interaction was however only present during the first COVID-19 peak when severe lockdown restrictions came into place, but not in the post-peak period when restrictions were being eased. The study found few differences across demographic groups. A private garden was relatively more beneficial for men than for women during but not after the first peak. The results suggest that both public and private green space are an important resource for health and wellbeing in times of crisis.

Concentrated Learning Experiences Across Two Different Health-Systems

While many public pharmacy schools have an adjoining health-system to accommodate their students, some pharmacy programs form partnerships with non-affiliated health-systems to precept students. These health-systems often afford students the opportunity to complete multiple rotations within a single organization, offering decreased onboarding time and more longitudinal experiences. Two autonomous partnerships were developed with independent healthcare systems for concentrated learning experiences during the advanced pharmacy practice experiences year. Each program differs in student requirements and is overseen by the practice site, with participation by area faculty. A survey assessed professional skill set development, achievement of program goals during the experiential year, and student satisfaction of a concentrated learning experience. A comparison between programs was completed to assess for consistency in student experiences. Nineteen students (83%) responded to the survey. Students from both health-systems reported similarities in professional skill growth. Likewise, all students reported achievement of program goals and overall satisfaction with their experiential training. Independently managed concentrated learning experiences provided evidence of consistent growth in student professional development and achievement of programmatic goals. Partnerships with non-affiliated healthcare systems can provide a rich training ground for student learners.

Mapping Parents’ Journey Following Prenatal Diagnosis of Congenital Heart Disease (T315C)

1.Describe Results from this analysis on how parents process and cope after receiving a prenatal diagnosis of congenital heart disease.2.Recognize that the parental role on the medical team differs prenatally and postnatally. Parents who receive a prenatal diagnosis of congenital heart disease (CHD) experience more stress than those who receive one postnatally, potentially due to the pervasive prenatal uncertainty experienced. In order to identify and support parents’ processing and coping, their longitudinal emotional experience must first be understood. To better understand parents’ accounts of their longitudinal prenatal and postnatal experience—particularly processing and coping mechanisms—to identify strategies to improve support. This single-center, longitudinal qualitative study included pregnant mothers and their support persons followed in fetal cardiology clinic for suspected CHD from May through August 2019. Twenty-seven individuals from 17 families participated in 62 phone interviews during pregnancy and postpartum, 27 after the initial cardiology consultation, 15 after a follow-up visit, and 20 after birth. Applied thematic analysis was used to code and analyze professionally transcribed interviews. Coding and codebook revisions occurred iteratively, with intercoder reliability assessed routinely. One author coded all transcripts; a second independently reviewed one-fifth of the transcripts at fixed intervals to ensure interrater reliability >80%. Most interviewees were mothers (16 [59%]) or fathers (8 [30%)]. Fetal diagnoses included a range of severe CHD. Prenatally, parents sought to maintain hope while understanding the diagnosis; their coping styles varied depending on prognosis severity. Postnatally, with confirmation of prenatal diagnoses, parents’ sense of control expanded, they desired more active engagement in clinical decision-making. In order to enhance effective communication, we must understand how parents conceptualize hope in relation to diagnostic understanding longitudinally. As prognostic uncertainty diminishes postpartum, the parental role on the team may shift, and providers may need to provide different support.

Abstract SS1-02: Racial disparities persist despite with uptake of digital breast tomosynthesis (DBT) for breast cancer screening

Abstract Background: Breast cancer screening with digital breast tomosynthesis (DBT) has been shown to improve recall rates and detection of invasive cancer compared to 2D full field digital mammography (FFDM). The Federal Drug Administration (FDA) approved the use of DBT in 2011, and the Centers for Medicare and Medicaid Services (CMS) approved coverage in 2015. We report a single institution’s longitudinal experience of the utilization and effectiveness of DBT for breast cancer screening over time with a focus on racial differences. Materials and Methods: The analytic population (n = 140,346) included females >18 years who underwent one or more breast cancer screening examinations performed at Johns Hopkins (a tertiary care institution) and affiliated sites between 4/1/2013 and 3/30/2020. Females were categorized as having only FFDM for screening (n = 43,323) or including DBT views (n = 97,023). Recall rate and cancer detection rate were compared between the two groups overall and stratified by race using the Chi-squared test and Fishers Exact test. Univariate and multivariate logistic regression was used to calculate odds ratios (ORs) and 95% confidence intervals (CIs) of having a DBT screening mammogram compared to an FFDM mammogram adjusted for year, race, and an interaction term between year and race. Results: The mean age was 58.9 +/- 10.8 years for the FFDM group and 60.3 +/- 11.1 years for the DBT group. A larger percentage of White patients (62% FFDM vs 71.1% DBT) than Black patients (30.4% FFDM vs 22.6% DBT) or Asian patients (3.8% FFDM vs 3.0% DBT) were in the DBT group (p<0.001). During the study period, there was rapid increased in utilization of DBT. In year 1 (4/1/2013-3/30/2014), 2791/14841 (18.8%) of patients had a screening mammogram with DBT. By year 3, during which CMS approved coverage of DBT, this increased to 15069/21304 (70.7%). By year 6, 18759/20929 (90.0%) included DBT views. All women irrespective of race had similar increases in utilization rates\ of DBT during the study period (effect modifier term OR 0.99, 95% CI 0.98-1.00). However, Black women and Asian women were significantly less likely to have a screening study with DBT compared to White women (Black women: OR 0.51, 95% CI 0.48-0.70; Asian women: OR 0.59, 95% CI 0.57-0.80). Overall the DBT group had lower recall rate compared to the FFDM group (9.1% versus 11.2%, p<0.001). This was observed for White women (8.6% vs 10.7, p<0.001), Black women: 10.4% vs 11.9% p=0.001) but not Asian women (11.5% vs 11.6%, p=0.97). The DBT group also had higher cancer detection rate overall compared to the FFDM group (6.0 vs 4.1, p<0.001). This was observed for White women (7.3 vs 4.5, p<0.0001); Black women (7.1 vs 4.3, p=0.001), and Asian women (10.4 vs 2.6, p=0.01). Conclusions: We observed racial differences in the utilization of DBT for screening mammography, which could have significant clinical implications given the improved recall rate and cancer detection of DBT over the study period. Longer follow up is needed to understand the impact of these racial differences. Studies are also needed to understand and address existing obstacles such as socioeconomic level, insurance status, and education to reduce the disparity preventing all patients equitable access to DBT. Citation Format: Emily B Ambinder, Eniola Oluyemi, Kala Visvanathan. Racial disparities persist despite with uptake of digital breast tomosynthesis (DBT) for breast cancer screening [abstract]. In: Proceedings of the 2020 San Antonio Breast Cancer Virtual Symposium; 2020 Dec 8-11; San Antonio, TX. Philadelphia (PA): AACR; Cancer Res 2021;81(4 Suppl):Abstract nr SS1-02.

Intercultural education in Kosovo: A longitudinal case study

This longitudinal qualitative study was conducted with Kosovo PhD students over a 3-year period who engaged in an ongoing intercultural education project at the University of Pristina’s Faculty of Education in Kosovo. The purpose of this article is to deepen the understanding of intercultural education with Kosovo as a critical case study. The data included pre-and post-open-ended surveys, one on one interviews, and follow up interviews regarding intercultural education during the longitudinal experiences. The findings of the study suggest the need to contextualize the issues of intercultural education and integrate local to global connections in relevant teaching, research, and service.

Teamwork in the time of COVID-19.

Strong and effective clinical teamwork has been shown to improve medical outcomes and reduce medical errors. Incorporating didactic and clinical activities into undergraduate medical education in which students work in teams will develop skills to prepare them to work in clinical teams as they advance through their education and careers. At the Yale School of Medicine, we foster the development of team skills in the classroom through team‐based learning (TBL) and in clinical settings with the Interprofessional Longitudinal Clinical Experience (ILCE). Both TBL and ILCE require students work in close physical proximity. The COVID‐19 pandemic forced us to immediately adapt our in‐person activities to an online format and then develop clinical and interprofessional experiences that adhere to social distancing guidelines. Here we describe our approaches to solving these problems and the experiences of our students and faculty.

Longitudinal experience with Studer neobladders: Outcomes and complications.

This study aims to assess the longer-term functional, anatomical, and metabolic outcomes of patients who underwent Studer neobladder (SNB) urinary diversion. A retrospective review of patients who underwent SNB at a single center from 1995-2017 (n=116) was performed. Demographics, comorbidities, pathological data, and longer-term functional, anatomical, and metabolic outcomes were collected from hospital records. The primary outcome was voiding function of patients at most recent followup. Secondary outcomes included postoperative complications, renal function, nephrolithiasis, infections, and metabolic outcomes. Excluding those with incomplete followup data, 72 patients with a minimum followup of one year were included for analysis. Median followup was 70±11 months, with 52.8% of patients having ≥5 years of followup. Clean intermittent catheterization (CIC) was used by 22.2% of patient at most recent followup, which was mostly necessitated by bladder overdistension, deteriorating renal function, or recurrent urosepsis despite timed voiding. Patients experienced more daytime and nighttime urinary incontinence in the early postoperative setting, which improved over time. Generally, renal function declined over time; poorer long-term renal function was predicted by hydronephrosis within one year (p=0.002). Longer-term followup of SNB reveals significant but manageable complications. Gradual decline in renal function was common. Strict adherence to bladder emptying protocols (e.g., timed voiding or CIC) may reduce incidence of renal deterioration, metabolic disorders, and urinary dysfunction. Early onset (<1 year) of hydronephrosis may indicate a need for intervention to preserve long-term renal function.

Early longitudinal experiences increase medical student self-efficacy.

This article was migrated. The article was marked as recommended. Background: The purpose of this study was to investigate the impact of early longitudinal preceptorship experiences on the evolution of general self-efficacy and patient-centeredness self-efficacy through medical school. Methods:Validated surveys for general self-efficacy and patient-centeredness self-efficacy were administered in an allopathic medical school at three timepoints. These data were stratified by traditional and longitudinal preceptorship groups and analyzed using Generalized Estimating Equations. Qualitative analysis of narrative medicine essays by the same cohort during their preceptorship experiences was also performed. Results: While general self-efficacy remained largely unchanged over time, patient-centeredness self-efficacy measures increased throughout medical school in the whole cohort (N=157). The longitudinal preceptorship group had higher gains in patient-centeredness self-efficacy, especially in the domain of exploring patient perspectives (p<0.05). The qualitative analysis of narrative medicine essays showed those in longitudinal preceptorships were more likely to discuss health care systems issues, consider psychosocial factors, and perceive themselves as active members of the care team. Discussion:Our study indicates greater patient-centeredness attitudes over time among students who have early longitudinal experiences, perhaps due to the self-efficacy building nature of these experiences. Our research suggest that medical school programs should consider incorporating opportunities for early longitudinal clinical experiences for their students.

Longitudinal experiences and impact of the COVID-19 pandemic among people with past or current eating disorders in Sweden

Longitudinal experiences and impact of the COVID-19 pandemic among people with past or current eating disorders in Sweden

Chapter 6 - The role of optical coherence tomography in the diagnosis of afferent visual pathway problems: A neuroophthalmic perspective

Optical coherence tomography (OCT) is a noninvasive ocular imaging technique that has become a standard tool in neuroophthalmic practice. Specifically, OCT captures retinal manifestations of neuroaxonal injury caused by lesions along anterior and posterior regions of the afferent visual pathway, in patients presenting with vision loss. More recently, the advent of OCT angiography (OCTA) has enabled evaluation of the choroidal and retinal microvasculature, thus informing our understanding regarding vascular mechanisms associated with optic nerve and retinal injuries. Much of our longitudinal experience with OCT in the field of neuroophthalmology has been acquired from the study of optic neuritis (ON) caused by inflammatory disorders of the central nervous system (CNS). Over the past two decades, OCT has emerged as a surrogate endpoint for CNS neuroaxonal injury in multiple sclerosis (MS) research trials. On a more pragmatic level, OCT is used in the clinical arena to diagnose ON associated with: MS, neuromyelitis optica spectrum disorder (NMOSD), and myelin oligodendrocyte glycoprotein (MOG) antibody associated disease (MOGAD). Subsequent advancements in swept-source (SS) and enhanced depth imaging (EDI) have established OCT as the new "gold standard" in the diagnosis of optic disc drusen. Recent studies have highlighted pathognomonic OCT features that distinguish cases of true papilledema from pseudopapilledema, in patients presenting with undifferentiated optic disc elevation. Preoperative OCT measures of neuroaxonal integrity have shown prognostic value in predicting postoperative visual outcomes for patients with compressive anterior visual pathway lesions. Finally, OCT is indispensable in differentiating optic neuropathies from retinal diseases in patients with visual loss and a nondiagnostic fundus examination. An in-depth discussion regarding the technical aspects of OCT is beyond the scope of this chapter. Instead, we wish to highlight the value OCT brings to the diagnosis and management of common neuroophthalmic conditions, with emphasis on optic neuropathies and retinal disorders.

Implementation and Initial Evaluation of a Research and Scholarship Training Pathway in a Doctor of Pharmacy Curriculum

Objective. To design, implement, and assess the initial impact of a pharmacy student research and scholarship training pathway.Methods. The Research and Scholarship in Pharmacy (RASP) pathway was designed to create a longitudinal, elective pathway within a Doctor of Pharmacy (PharmD) curriculum at a single institution. The pathway consisted of three elective courses built around a faculty-mentored scholarly project where students framed an answerable question, generated and interpreted relevant data, and communicated their findings in oral and written form. Following implementation, a retrospective, multi-method analysis was conducted to evaluate the impact of the program on the initial two student cohorts that completed it and assess their perceptions of the value of the pathway.Results. Fifty students (25 in each of two cohorts) completed the three-course sequence. Students were supported by 33 distinct faculty mentors. Thirty-eight (76%) students presented an abstract derived from their project at a national meeting. The first cohort exit survey (96% response rate) revealed positive student perceptions regarding the value of and satisfaction with the research pathway. Twenty-three (96%) students were satisfied with their research experience, 21 (88%) were satisfied with their faculty mentor, and 24 (100%) were satisfied with their development of project management skills. In the first cohort, 10 (40%) students published an original research manuscript within one year of graduation.Conclusion. The Research and Scholarship in Pharmacy pathway feasibly and effectively provided a mechanism for students to engage in a faculty-mentored longitudinal research experience within a PharmD curriculum that promoted skill development and opportunities for scholarship. Initial implementation demonstrated high rates of student satisfaction, low rates of student attrition, and high rates of scholarly output.

Pharmacy resident interventions and clinical progression in a student‐run free clinic

AbstractIntroductionStudent‐run free clinics provide critical medical services to underserved populations. Pharmacy resident involvement in this setting is not thoroughly documented in the current literature.ObjectivesTo evaluate the progression of post‐graduate year one (PGY1) residents through a longitudinal experience in a medical student‐run free clinic by assessing the interventions made and to characterize the clinic practice and patient population.MethodsDatabases of pharmacist interventions, clinic demographics, and prescriptions were assessed from July 2016 through August 2018. The primary outcome was the frequency of each intervention type per subject‐visit made by PGY1 residents across quarterly segments (August‐October, November‐January, February‐April, and May‐June). Interventions were excluded if provided by a non‐PGY1 pharmacist or during the annual training period. Secondary outcomes included the proportion of advanced practice skill interventions and frequency of total interventions across quarterly segments.ResultsThere were 604 interventions (604/1056; 57.2%) included after applying exclusion criteria. Interventions most performed were medication therapy recommendation (209/604; 34.6%) and prescription facilitation (201/604; 33.3%). There was no statistically significant difference amongst the quarters for any individual intervention type (all P &gt; .05). This held true for total interventions (P = .115). There was an association identified between time and delivery of advanced interventions per subject‐visit (P = .004), with higher rates identified in the second and third quarters (P = .508 and .448, respectively) compared with the first and fourth quarters (P = 0.327 and 0.333, respectively). The diseases with the most interventions by residents included pain management, dermatology, pulmonary, and cardiovascular.ConclusionThere was no change in frequency of types or total interventions found in this analysis, although there was an increased frequency of advanced interventions detected in the second and third quarter. A unique learning experience for pharmacy residents was successfully implemented in an underserved, ambulatory setting.

Is Classroom Gamification Opposed to Performance?

Learning through digital media is currently considered as a mixture of methodologies that aim to approach the reality of students to motivate them. Gamification emerges as one of the pedagogical methodologies on the rise in digital classrooms, but is it really practical? What are its effects? A gamification longitudinal case-study experience was carried out in the subject: complements for disciplinary training in technology of the master’s degree of secondary school teachers (technology specialty) that is taught at the Universitat Politècnica de Catalunya, where gamified activities and alternatives to traditional master teaching have been introduced in a progressive way throughout three academic years (2016/17 to 2018/19). The results show that there is a negative correlation between the numerical scores of the different components of the evaluation and the marks obtained in the activities of gamification. It is surprising that the group less involved in the gamification obtained better academic results, although gamification improved the motivation and the valuations of the subject, due to the inclusion of more games in the course. This raises doubts on whether the positive effects of gamification on the climate of the classroom and on motivation are opposed to academic results.

Impact of a health‐system longitudinal advanced pharmacy practice experience on student growth and postgraduate career placement

AbstractWhile most longitudinal advanced pharmacy practice experiences (LAPPEs) include sequential core rotations, programs vary regarding additional elements offered. Pharmacy residency programs have become increasingly competitive with applicants outnumbering available positions. LAPPEs can help students improve their candidacy for postgraduate training while also benefiting health systems.ObjectiveTo describe the health‐system perspective of a LAPPE designed to build professional skills in students to best prepare them for subsequent career pursuits.MethodsStudents enrolled in the Eskenazi Health (EH) LAPPE were asked to complete pre‐ and postprogram assessments regarding career interests, strengths, areas for improvement, and goals. Students were also asked to rank their comfort level with 27 clinical skills in four categories. Additionally, a survey was distributed to all program alumni to gather demographic and qualitative data.ResultsIn the 9 years since inception, 52 students have enrolled in the EH LAPPE. Of the 44 program graduates surveyed, 41 responded (93%). Of these, 95% completed postgraduate training in 18 different states and two obtained jobs directly following graduation. The majority (54%) applied for a postgraduate year one (PGY1) residency at our institution, of which 11 (27%) matched for at least 1 year of residency training. A total of 32 students completed the pre‐ and postprogram skills assessments which demonstrated a statistically significant increase in comfort level in all 27 skills, with a median increase of 1.5 on a 4‐point scale. Clinical research, mentors, and mock interviews were identified as most helpful to program alumni.ConclusionsThe EH LAPPE can serve as an example for health‐systems wishing to institute a similar program. Students experienced perceived growth and increased confidence in various patient care activities, and successful career placement suggests that students benefited from career preparation elements of the LAPPE. LAPPEs can provide benefits to health systems through student contributions and should be considered by sites looking for growth and unique precepting opportunities.

Bayesian Multivariate Mixed-Effects Location Scale Modeling of Longitudinal Relations Among Affective Traits, States, and Physical Activity.

Intensive longitudinal studies and experience sampling methods are becoming more common in psychology. While they provide a unique opportunity to ask novel questions about within-person processes relating to personality, there is a lack of methods specifically built to characterize the interplay between traits and states. We thus introduce a Bayesian multivariate mixed-effects location scale model (M-MELSM). The formulation can simultaneously model both personality traits (the location) and states (the scale) for multivariate data common to personality research. Variables can be included to predict either (or both) the traits and states, in addition to estimating random effects therein. This provides correlations between location and scale random effects, both across and within each outcome, which allows for characterizing relations between any number of personality traits and the corresponding states. We take a fully Bayesian approach, not only to make estimation possible, but also because it provides the necessary information for use in psychological applications such as hypothesis testing. To illustrate the model we use data from 194 individuals that provided daily ratings of negative and positive affect, as well as their physical activity in the form of step counts over 100 consecutive days. We describe the fitted model, where we emphasize, with visualization, the richness of information provided by the M-MELSM. We demonstrate Bayesian hypothesis testing for the correlations between the random effects. We conclude by discussing limitations of the MELSM in general and extensions to the M-MELSM specifically for personality research.