Mean Likert Scale Score Research Articles

The Attitudes and Perceptions of Saudi EFL Learners Toward Using English Language Learning Mobile Apps for Learning English

This study investigated the views of Saudi EFL students toward using English Language Learning Mobile Apps (MELLA) to learn English. A quantitative approach consisting of questionnaires was used to collect data from eighty-nine participants who shared their attitudes and perceptions about MELLAs. Questionnaire items were rated on a Likert scale which ranged from “Strongly Disagree” (1, very low) to “Strongly Agree” (5, very high). Mean Likert scale scores were used to evaluate participants’ responses. The study found that Saudis’ perceptions of MELLA exceeded their attitudes. Moreover, gender differences were found in Saudis’ attitudes toward the use of MELLA. The highest-ranking female attitude mean scores were observed on items related to pronunciation, dictionary, and listening apps while the highest-ranking male attitude mean scores were related to dictionary, listening, and vocabulary apps. Furthermore, the Saudis’ mean score for MELLA perception was higher than the mean score for MELLA attitude. Results also show that females have a higher perception than males. Finally, minor gender differences regarding MELLA perception were also found; the highest female mean scores were based on easiness and flexibility in the use of apps while males highly perceived the convenience of using an app anywhere and at any time as being most important to them.

Knowledge and Confidence of Obstetrics and Gynecology Residents in the Evaluation and Management of Heavy Menstrual Bleeding Due to Inherited Bleeding Disorders.

Heavy menstrual bleeding (HMB) is common, and 20-30% of patients presenting with HMB are diagnosed with an inherited bleeding disorder (IBD). Despite the frequent association of HMB with bleeding disorders, specific learning objectives on this topic are lacking for Obstetrics and Gynecology (OBGYN) residents. We sought to determine the exposure of OBGYN residents to didactics, clinical training, and confidence in evaluation and management of patients with HMB due to IBDs. Prospective survey of OBGYN residents through email solicitation. Residents were invited to complete an anonymous 26-item survey, querying residents' confidence in evaluation and management of HMB in patients with and without IBDs. In total, 239 OBGYN residency programs were invited to participate and 20 programs responded. Among 388 residents, 84 completed the survey (21.6%). The majority reported didactics on HMB evaluation (n = 71, 85.5%) and treatment (n = 77, 92.8%); however, for HMB due to IBDs, only 35 residents (42.4%) reported didactics on evaluation and 28 (33.7%) reported didactics on treatment. Confidence in evaluation and management of HMB was high but decreased significantly with an IBD. Residents who received didactics on IBDs reported more confidence in their evaluation than residents who did not receive didactics (mean Likert scale score of 3.67 vs. 3.23, p = 0.002). Increasing postgraduate year level was associated with more confidence in treatment (p < 0.001) and did not differ based on type of training program (p = 0.825). OBGYN residents have decreased confidence in evaluation and management of HMB due to IBDs. Resident confidence increases with didactics and training. Residents would benefit from curricula designed to address this deficit in training.

The Perceptions and Attitudes of Saudi EFL Students Toward the Use of Communicative Language Teaching in Oral Communication Classes

Communicative Language Teaching (CLT) is widely and extensively practiced in language teaching, especially in EFL classes. In fact, most educators consider it to be the most effective and practical approach to language teaching. Early studies indicated that the positive or negative attitudes of learners toward CLT can affect their language learning process. As a result, the current study aims to unveil the perceptions and attitudes of Saudi college and graduate students toward the implementation of CLT to enhance their speaking and listening skills. Furthermore, gender role is also considered since Saudi has a segregated system of education. Questionnaire items adopted from Komol et al. (2020) were rated on a Likert scale which ranged from “Strongly Disagree” (1, very low) to “Strongly Agree” (5, very high). Mean Likert scale scores were used to evaluate the responses of participants along with the standard deviation (SD). The study found that Saudi participants displayed a higher perception of CLT activities when compared to their attitude. Moreover, females showed a higher perception and attitude toward CLT activities than males did. The highest mean scores of perception items among females are “Making a short video” because it allows them to get more exposure to English use while males have chosen “Teacher’s instruction on class CLT activities” as more significant. Concerning attitudinal items, males believe in using CLT activities to promote their language proficiency. In contrast, females believe in using role-play activities to improve their language proficiency. Finally, females showed less preference for CLT group or class activities than males did.

Evaluating artificial intelligence's role in lung nodule diagnostics: A survey of radiologists in two pilot tertiary hospitals in China.

This study assesses the perceptions and attitudes of Chinese radiologists concerning the application of artificial intelligence (AI) in the diagnosis of lung nodules. An anonymous questionnaire, consisting of 26 questions addressing the usability of AI systems and comprehensive evaluation of AI technology, was distributed to all radiologists affiliated with Beijing Anzhen Hospital and Beijing Tsinghua Changgung Hospital. The data collection was conducted between July 19, and 21, 2023. Of the 90 respondents, the majority favored the AI system's convenience and usability, reflected in "good" system usability scale (SUS) scores (Mean ± standard deviation [SD]: 74.3 ± 11.9). General usability was similarly well-received (Mean ± SD: 76.0 ± 11.5), while learnability was rated as "acceptable" (Mean ± SD: 67.5 ± 26.4). Most radiologists noted increased work efficiency (Mean Likert scale score: 4.6 ± 0.6) and diagnostic accuracy (Mean Likert scale score: 4.2 ± 0.8) with the AI system. Views on AI's future impact on radiology careers varied (Mean ± SD: 3.2 ± 1.4), with a consensus that AI is unlikely to replace radiologists entirely in the foreseeable future (Mean ± SD: 2.5 ± 1.1). Radiologists at two leading Beijing hospitals generally perceive the AI-assisted lung nodule diagnostic system positively, citing its user-friendliness and effectiveness. However, the system's learnability requires enhancement. While AI is seen as beneficial for work efficiency and diagnostic accuracy, its long-term career implications remain a topic of debate.

The Medical Student Guide to Pharmacy: Piloting an Interactive Textbook on Basic Pharmacology Principles and Clinical Correlations.

Despite the wide use of medications in clinical practice, graduating medical students often feel unprepared for the task of prescribing upon starting residency. With recent educational initiatives aiming to transform learning modalities, we sought to pilot an interactive textbook on basic pharmacology principles at our institution as a supplement to first-year lectures and assess its subjective impact on students' knowledge of content as well as confidence to apply material in the real world through pre- and post-intervention surveys. First-year medical students were invited to complete non-validated, voluntary, anonymous, emailed, online surveys consisting of Likert scale and free-text response questions. Our investigation served as a pilot test for future iterations of this research. Response rates for the pre- and post-intervention surveys were 73/145 (50%) and 38/145 (26%), respectively, with the post-intervention survey further reduced to 13 individuals who indicated use of the interactive textbook. Questions regarding interactive textbook chapters that overlapped with course content were excluded from data analysis due to an inability to separate learning gains from lectures versus the interactive textbook. Post-intervention survey responses all showed significant changes in mean Likert scale scores on student-perceived knowledge and confidence to apply material with P < .001. Free-text response questions revealed limited exposure to the field of pharmacy and interactions with pharmacists prior to medical school. Our pilot study on the initial use of an interactive textbook titled The Medical Student Guide to Pharmacy presented us with valuable insight into providing first-year medical students with a clinically oriented supplemental resource within coursework on basic pharmacology. Challenges for the future include better integrating the interactive textbook into class lectures to facilitate increased use by students as well as developing more targeted, validated assessments of the impact it has on students' learning.

The Implications of Virtual Learning on Plastic Surgery Education: A National Survey of Plastic Surgery Residents and Fellows.

Graduate medical education during the COVID-19 pandemic has seen the shift to a "virtual learning" format in many aspects of training. The purpose of this study was to describe the perceived strengths and weaknesses of virtual learning compared with a conventional, in-person format. A 45-question survey was sent to independent and integrated plastic surgery residents and postresidency fellows nationally. The survey collected basic demographic information and evaluated three general categories of virtual learning in comparison to an in-person format: (1) time, (2) learning proficiency, and (3) collaboration. In total, 108 surveys were submitted from 48 different training programs. Participants reported that virtual learning was more efficient (mean: 3.9), conducive to more free time (mean: 3.9), and a more comfortable medium for expressing opinions (mean: 3.5) and asking questions (mean: 3.6) compared with an in-person format. When stratified between training levels, the PGY 1-3 group reported more difficulties in exam preparedness (P = 0.05), motivation to study (P = 0.01) and less time-saving benefits (P = 0.05) with a virtual format than the PGY 4+ group. Lastly, respondents who had higher self-reported levels of multitasking were found to have lower mean Likert scale scores on all questions related to "time," "learning proficiency," and "collaboration" (P < 0.01). A virtual and in-person hybrid approach toward plastic surgery education may be beneficial for encouraging flexibility. Our results demonstrate impairment with collaboration and learning proficiency with a virtual format, especially with increased multitasking, but increased comfort with expressing opinions and asking questions.

Circumcision wound dressing with octylcyanoacrylate tissue adhesive

Circumcision wounds are commonly dressed with paraffin gauze dressings. Octylcyanoacrylate tissue adhesive (Dermabond; Ethicon, US) is increasingly being used for wound closure, as well as wound dressing. This study compared the outcomes of tissue adhesive dressing versus paraffin gauze dressing for circumcision wounds. Adult male patients undergoing circumcision were randomised into two groups: tissue adhesive dressing (study group) or paraffin gauze dressing (control group). They were followed up at two weeks and at two months after surgery. The primary objective of this study was to determine the difference in patient-reported dressing satisfaction at two week follow-up. Our secondary outcomes included operation time, postoperative pain, postoperative complications, patient-reported cosmetic satisfaction, surgeon-reported cosmetic satisfaction, and surgeon-reported objective measure of cosmetic outcome using a validated scale. A cohort of 40 patients was randomised into two equal groups, study and control. Tissue adhesive dressing was associated with a significantly better patient-reported dressing satisfaction, with a mean Likert scale score of 4.53±0.51 for the study group versus 3.20±1.24 for the control group (p<0.001). It was also associated with a significantly better patient-reported cosmetic satisfaction of 4.58±0.51 versus 4.00±1.12 (p<0.05), respectively. There was no difference in operation time, postoperative pain, postoperative complications or surgeon-reported cosmetic outcomes. Tissue adhesive dressing is an acceptable alternative to paraffin gauze dressing for circumcision wounds. This option should be offered to all patients undergoing circumcision.

Expert consensus on the management of systemic sclerosis-associated interstitial lung disease

BackgroundSystemic sclerosis (SSc) is a rare, complex, connective tissue disorder. Interstitial lung disease (ILD) is common in SSc, occurring in 35–52% of patients and accounting for 20–40% of mortality. Evolution of therapeutic options has resulted in a lack of consensus on how to manage this condition. This Delphi study was initiated to develop consensus recommendations based on expert physician insights regarding screening, progression, treatment criteria, monitoring of response, and the role of recent therapeutic advances with antifibrotics and immunosuppressants in patients with SSc-ILD.MethodsA modified Delphi process was completed by pulmonologists (n = 13) and rheumatologists (n = 12) with expertise in the management of patients with SSc-ILD. Panelists rated their agreement with each statement on a Likert scale from − 5 (complete disagreement) to + 5 (complete agreement). Consensus was predefined as a mean Likert scale score of ≤ − 2.5 or ≥ + 2.5 with a standard deviation not crossing zero.ResultsPanelists recommended that all patients with SSc be screened for ILD by chest auscultation, spirometry with diffusing capacity of the lungs for carbon monoxide, high-resolution computed tomography (HRCT), and/or autoantibody testing. Treatment decisions were influenced by baseline and changes in pulmonary function tests, extent of ILD on HRCT, duration and degree of dyspnea, presence of pulmonary hypertension, and potential contribution of reflux. Treatment success was defined as stabilization or improvement of signs or symptoms of ILD and functional status. Mycophenolate mofetil was identified as the initial treatment of choice. Experts considered nintedanib a therapeutic option in patients with progressive fibrotic ILD despite immunosuppressive therapy or patients contraindicated/unable to tolerate immunotherapy. Concomitant use of nintedanib with MMF/cyclophosphamide can be considered in patients with advanced disease at initial presentation, aggressive ILD, or significant disease progression. Although limited consensus was achieved on the use of tocilizumab, the experts considered it a therapeutic option for patients with early SSc and ILD with elevated acute-phase reactants.ConclusionsThis modified Delphi study generated consensus recommendations for management of patients with SSc-ILD in a real-world setting. Findings from this study provide a management algorithm that will be helpful for treating patients with SSc-ILD and addresses a significant unmet need.

Usability and Clinician Acceptance of a Deep Learning-Based Clinical Decision Support Tool for Predicting Glaucomatous Visual Field Progression.

We updated a clinical decision support tool integrating predicted visual field (VF) metrics from an artificial intelligence model and assessed clinician perceptions of the predicted VF metric in this usability study. To evaluate clinician perceptions of a prototyped clinical decision support (CDS) tool that integrates visual field (VF) metric predictions from artificial intelligence (AI) models. Ten ophthalmologists and optometrists from the University of California San Diego participated in 6 cases from 6 patients, consisting of 11 eyes, uploaded to a CDS tool ("GLANCE", designed to help clinicians "at a glance"). For each case, clinicians answered questions about management recommendations and attitudes towards GLANCE, particularly regarding the utility and trustworthiness of the AI-predicted VF metrics and willingness to decrease VF testing frequency. Mean counts of management recommendations and mean Likert scale scores were calculated to assess overall management trends and attitudes towards the CDS tool for each case. In addition, system usability scale scores were calculated. The mean Likert scores for trust in and utility of the predicted VF metric and clinician willingness to decrease VF testing frequency were 3.27, 3.42, and 2.64, respectively (1=strongly disagree, 5=strongly agree). When stratified by glaucoma severity, all mean Likert scores decreased as severity increased. The system usability scale score across all responders was 66.1±16.0 (43rd percentile). A CDS tool can be designed to present AI model outputs in a useful, trustworthy manner that clinicians are generally willing to integrate into their clinical decision-making. Future work is needed to understand how to best develop explainable and trustworthy CDS tools integrating AI before clinical deployment.

Evaluation of the Satisfaction of Patients Seen in the Dermatology Department of a Spanish Tertiary Hospital.

Patient satisfaction is of great importance and is a key factor in the quality of care. The most commonly used measure of this factor is satisfaction surveys. This study used the modified SERVQHOS healthcare quality survey model, which adapts the SERVQUAL survey. The main objective was to determine the degree of satisfaction of patients seen in the outpatient department of the Dermatology Service, as well as to describe and detect those aspects that could be improved to offer better quality care. A total of 250 patients responded to the survey. The mean Likert scale score for the 19 items on the perceived quality of care was 4.17 ± 0.796 points. Up to 92.8% were satisfied or very satisfied with the care received. All items were statistically correlated with overall satisfaction (p < 0.001). In the multivariate study, the variables with predictive capacity in relation to overall satisfaction (p < 0.05) were “the technology of the medical equipment”; “the directions to the consultation”; “the confidence that the staff transmits”; “the state of the consultation”; and “the interest of the staff in solving problems”. Satisfaction was significantly higher in men (p < 0.05), with a level of education up to primary school (p < 0.05) and no work activity (p < 0.001). The final mean score in the degree of perceived satisfaction was very high, indicating that the expectations of the patients were exceeded, and showing that satisfaction is closely linked to the qualities and skills of the staff in their relationship with the patient.

Patient and provider perspectives on telemedicine utilization for Gynecologic Oncologic care among underserved women at an urban teaching hospital in the era of COVID-19 (279)

Objectives: The use of telemedicine has dramatically increased during the COVID-19 pandemic, requiring patients and providers to quickly adapt to this new mode of healthcare delivery. Our study objective was to describe patient and provider experiences using telemedicine for gynecologic oncology (GO) care among medically underserved women in an urban academic teaching hospital.Methods: We conducted a prospective study evaluating patient and provider acceptability and feasibility with telemedicine among medically underserved women seeking GO care from January to August 2021. Eligible patients for this sub-analysis included those using telemedicine for GO visits and preoperative or postoperative gynecologic care at a government-funded clinic in New York City. Providers included residents, GO fellows, and nurse practitioners (NPs). A newly developed telemedicine survey and a modified version of the validated Telemedicine Usability Questionnaire (TUQ) were administered to providers and patients, respectively, for each visit. The TUQ has six subscales to assess telemedicine usability, including usefulness, ease of use, interface quality, interaction quality, reliability, and satisfaction with mean Likert scale scores calculated for all questions. All statistical analyses were completed using the Wilcoxon signed-rank test. Results: A total of 166 surveys were completed with 28 provider and 27 patient surveys eligible for inclusion in this sub-analysis. 81% (22) visits were completed by video, 19% (5) by phone. Median patient age was 43 (24-67), 52% (14) had at least a college degree, 30% (8) self-identified as Asian, 19% (5) as Black, and 15% (4) as Hispanic. The overall TUQ mean score was 4.26. Subscale mean scores were calculated for usefulness (4.60), ease of use (4.48), interface quality (4.44), interaction quality (4.75), reliability (3.74), and satisfaction/future use (4.59). The reliability mean score, which measures whether patients think telemedicine visits are as good as in-person visits, was significantly lower compared to the other subscales (Table 1). Of the 28 providers, 68% (19) were residents and 32% (9) were GO fellows or NPs. Resident providers’ mean scores for self-perceived ability to adequately counsel patients using telemedicine was significantly lower than that of GO fellows and NPs (p=0.01). Of the 25 paired patient-provider surveys within this cohort, there was high concordance between providers’ self-perceived ability to counsel patients via telemedicine and patients’ satisfaction with the telemedicine services (p=1.00).Conclusions: Women presenting for GO and perioperative visits reported positive experiences using telemedicine. While telemedicine may increase access to healthcare services, patient’s perceptions regarding equivalence to in-person visits is of particular interest in marginalized populations. Teaching hospitals must also evaluate whether providers feel adequately trained to deliver telemedicine visits, with a particular emphasis on trainees.

The need for artificial intelligence curriculum in medical education: A Canadian cross-sectional study of future oncology trainees.

e13583 Background: Emerging artificial intelligence (AI) technologies have diverse applications in medicine, with early evidence suggesting that AI tools can accurately perform key tasks in oncology. As AI tools advance towards clinical implementation, skills in how to use and interpret AI in a healthcare setting could become integral for physicians. This study seeks to assess exposure to AI in medical education among trainees interested in pursuing a career in oncology, and the need for AI education in medicine. Methods: A 32 question survey for Canadian undergraduate medical students was distributed to students at all 17 Canadian medical schools. The survey assessed the currently available and perceived need for learning opportunities about AI and barriers to educating about AI in medicine. Interviews were conducted with participants to provide narrative context to survey responses. Likert scale (LS) survey questions were scored from 1 (disagree) to 5 (agree), and analyzed using a two-sided one sample t-test vs a neutral value. Interview transcripts were analyzed using qualitative thematic analysis. Results are described as mean LS score ± standard deviation. Results: We received 486 responses from 17 of 17 medical schools. Of these respondents, 98 (20.2%) are willing to pursue a residency in an oncology-related field (pathology, radiology, general surgery, internal medicine, radiation oncology). Respondents agreed that AI applications in medicine would become common in the future (3.80±0.38) and would improve medicine (3.71±0.54). Further, respondents agreed that they would need to use and understand AI during their medical careers (3.76±0.572; 3.43±0.773), and that AI should be formally taught in medical education (3.43±0.756). In contrast, a significant number of participants indicated that they did not have any formal educational opportunities about AI (1.76±0.785) and that AI-related learning opportunities were inadequate (2.12±0.802). Interviews with 18 students were conducted. Emerging themes from the interviews were a lack of formal education opportunities and logistical challenges in adding AI to curriculum. Conclusions: A lack of educational opportunities about AI in medicine were identified across Canadian medical students. Given that medical students overwhelmingly believe that AI is important to the future of medicine, and AI tools are currently progressing towards clinical implementation, AI should be considered for inclusion in formal medical curriculum.

A Smartphone App (AnSim) With Various Types and Forms of Messages Using the Transtheoretical Model for Cardiac Rehabilitation in Patients With Coronary Artery Disease: Development and Usability Study.

BackgroundDespite strong evidence of clinical benefit, cardiac rehabilitation (CR) programs are currently underutilized and smartphone-based CR strategies are thought to address this unmet need. However, data regarding the detailed process of development are scarce.ObjectiveThis study focused on the development of a smartphone-based, patient-specific, messaging app for patients who have undergone percutaneous coronary intervention (PCI).MethodsThe AnSim app was developed in collaboration with a multidisciplinary team that included cardiologists, psychiatrists, nurses, pharmacists, nutritionists, and rehabilitation doctors and therapists. First, a focus group interview was conducted, and the narratives of the patients were analyzed to identify their needs and preferences. Based on the results, health care experts and clinicians drafted messages into 5 categories: (1) general information regarding cardiovascular health and medications, (2) nutrition, (3) physical activity, (4) destressing, and (5) smoking cessation. In each category, 90 messages were developed according to 3 simplified steps of the transtheoretical model of behavioral change: (1) precontemplation, (2) contemplation and preparation, and (3) action and maintenance. After an internal review and feedback from potential users, a bank of 450 messages was developed.ResultsThe focus interview was conducted with 8 patients with PCI within 1 year, and 450 messages, including various forms of multimedia, were developed based on the transtheoretical model of behavioral change in each category. Positive feedback was obtained from the potential users (n=458). The mean Likert scale score was 3.95 (SD 0.39) and 3.91 (SD 0.39) for readability and usefulness, respectively, and several messages were refined based on the feedback. Finally, the patient-specific message delivery system was developed according to the baseline characteristics and stages of behavioral change in each participant.ConclusionsWe developed an app (AnSim), which includes a bank of 450 patient-specific messages, that provides various medical information and CR programs regarding coronary heart disease. The detailed process of multidisciplinary collaboration over the course of the study provides a scientific basis for various medical professionals planning smartphone-based clinical research.

1431. Evaluating Physician Decision Making in Inpatient Antibiotic Prescription for Suspected Urinary Tract Infection

BackgroundPhysicians are constantly asked to evaluate inpatients for possible antibiotic treatment. As part of antibiotic stewardship it is imperative to understand the decision-making process behind a physician’s choice to prescribe antibiotics appropriately in an inpatient setting. Fuzzy Trace Theory (FTT) suggests that physicians use one of two methods in medical decision making; verbatim, employing a comprehensive risk benefit analysis, and gist, considering a bottom line analysis. MethodsSeventy-six hospitalists at Weill Cornell Medicine in Manhattan, New York received a survey with two reminders to evaluate their decision-making process. Five basic demographic questions regarding participant gender, race, background, age, and years in practice were asked. A clinical vignette describing an inpatient with a possible urinary tract infection (UTI) was followed with statements framing hypothetical antibiotic prescription. A seven point Likert scale with response choices from Strongly Disagree scored as one to Strongly Agree scored as seven was used to assess degree of participant agreement with each statement. Questions were presented in a random order to eliminate possible effects of questions clusters or question order. ResultsTwenty-six hospitalists completed the survey. Consistent with previous literature, the hospitalists surveyed displayed a gist interpretation of the risks and benefits of antibiotics, with a mean Likert scale score of 5.54 agreeing that there are benefits to antibiotic prescription, and a mean Likert scale score of 6.04, agreeing that there are risks to antibiotic prescription. . However, the clinicians surveyed ultimately found antibiotics to be a necessary risk given the possible benefit of improving patient health. The hospitalists surveyed also did not view antibiotic prescription to be a product of pressure from patient families, agreeing by a mean Likert scale score of 5.08 that the patient’s family will trust their physician to prescribe antibiotics if needed. ConclusionThese findings suggest that physician education to reduce overprescribing of antibiotics should underscore possible antibiotic risk, despite potential benefit. Disclosures Marshall J. Glesby, MD, Enzychem (Consultant)Gilead (Grant/Research Support)ReAlta Life Sciences (Consultant)Regeneron (Consultant, Grant/Research Support)Sobi (Consultant)Springer (Other Financial or Material Support, Royalties)UpToDate (Other Financial or Material Support, Royalties) Justin J. Choi, MD, Allergan (Consultant, Grant/Research Support)Roche (Consultant, Grant/Research Support)

Priorities for child health research across the UK and Ireland

BackgroundThe General and Adolescent Paediatric Research Network in the UK and Ireland (GAPRUKI) was established in 2016. The aims of GAPRUKI are to unite general paediatricians around the UK and...

The Efficacy of Virtual Subinternships as a Novel Educational Platform for Education and Recruitment.

The Efficacy of Virtual Subinternships as a Novel Educational Platform for Education and Recruitment.

Factors influencing international and U.S. dentists\u2019 interest in advanced periodontal education: a pilot study

BackgroundThe enrollment of international periodontal students in U.S. dental schools has been increasing in recent years. Interest in applying to a periodontics specialty program may differ between U.S and international dental school graduates. The purpose of this study is to assess, from the perspective of periodontal residents, (1) factors that interest dental students to apply to periodontics programs and (2) differences in background and interest between U.S and international graduates.MethodsA 20-question survey was sent out electronically to periodontics residents. The survey questions were designed to obtain information on the participants’ backgrounds, factors that influenced them to specialize in periodontics, and their preferred features of graduate periodontics programs. The data were analyzed using descriptive statistics for socio-demographic variables, a Wilcoxon two sample test to compare mean Likert scale scores, and Fisher’s exact test for associations between comparison groups.ResultsOf the two hundred residents invited to participate, 28% responded. The majority of the respondents stated that interest in implantology, previous exposure to periodontal procedures, interest in improving periodontal surgery skills, a good relationship with periodontics faculty, the residency curriculum, advanced program and faculty reputation as influencing factors in selecting periodontics as specialization. The majority of international graduates have up to $50,000 dollars in student debt; by comparison, half of the domestic graduates have a debt of over $250,000 dollars (p ≤ 0.05). Working experience as a dentist was significantly greater among international residents (73%) in comparison to U.S graduates (32%). In contrast with international graduates, U.S graduates more frequent reported that good relationships with the periodontics predoctoral faculty contributed to their interest in periodontics (p ≤ 0.05). Program cost and location had a greater impact on the decision of U.S. graduates than international graduates (p ≤ 0.05).ConclusionsOverall, factors associated with personal finance and predoctoral education have a greater impact on the decision of American graduates than international graduates to pursue an advanced education in periodontics, which may influence the increased enrollment of international students.

Influence of undergraduate medical education exposure to cadaveric dissection on choice of surgical specialty: a national survey of Canadian surgical residents.

BackgroundThe number of Canadian Residency Matching Service (CaRMS) applicants ranking surgical specialties as their first choice has declined over the past 20 years; concurrently, there has been a reduction in the number of hours spent teaching undergraduate medical education (UGME) anatomy, particularly with cadaveric dissection. The aim of this study was to determine the factors that most influence selection of a surgical specialty, with specific focus on the impact of UGME anatomy training.MethodsA 36-item cross-sectional survey was designed by experts in medical education and distributed to all current surgical residents in Canada in October 2018. Responses were recorded on a 5-point Likert scale or by means of list ranking. We analyzed univariable outcomes with a t test for continuous outcomes and the χ2 test for dichotomous outcomes.ResultsOf 1493 surgical residents, 228 responded to the survey (response rate 15.3%). Respondents reported experiences on core rotations and elective rotations, and access to a mentor as the most important factors in deciding to pursue a surgical residency. Anatomy training with or without cadaveric dissection was moderately influential in respondents’ first-choice CaRMS discipline (mean Likert scale score 2.97 [standard deviation (SD) 1.34] and 2.87 [SD 1.26], respectively). General surgery residents’ CaRMS applications were more likely to have been influenced by UGME anatomy training than the applications by residents in other surgical specialties (p < 0.001). The impact of UGME anatomy training did not vary between postgraduate years or between male and female residents.ConclusionCanadian surgical residents’ decision to apply to a surgical specialty did not seem to be strongly influenced by their UGME anatomy training, with or without cadaveric dissection, but, rather, by factors such as clinical experience and surgical mentorship. Further evaluation of groups that were more positively affected by their UGME anatomy training is warranted.

Treating Withdrawal and Pain in Inpatients With Opioid Use Disorder: A Brief Educational Intervention for Internal Medicine Residents.

IntroductionDespite the effectiveness of opioid agonist therapy (OAT) for treating patients with opioid use disorder (OUD), insufficient education remains a barrier to prescribing. Internal medicine (IM) residents are optimally positioned to facilitate use of OAT, especially in the inpatient setting. We implemented an educational intervention aimed at increasing IM residents' knowledge and confidence regarding prescribing OAT to inpatients with OUD.MethodsWe created a 35-minute, case-based presentation highlighting the management of opioid withdrawal using OAT and treating pain in inpatients on maintenance OAT. It was presented to IM residents beginning their general medicine ward rotations from November 2019 through January 2020. We developed a survey to measure participants' knowledge (mean number of questions correct out of five) and confidence (mean Likert-scale score, 1 = Not at all confident, 5 = Extremely confident, on each of five items) regarding prescribing OAT in the inpatient setting. We compared knowledge and confidence before versus 1 month after the intervention using paired Student t tests, with p < .05 indicating significance.ResultsOf 103 unique residents completing ward rotations, 29 (28%) completed both the pre- and 1-month postsurveys and were included in the analysis. The mean number of knowledge questions correct increased from 3.1 pre- to 4.3 postintervention, and mean confidence scores increased from below 2 pre- to over 3 postintervention in four of five items (ps < .001).DiscussionA brief, generalizable, educational intervention significantly increased residents' knowledge of and confidence in prescribing OAT in inpatients with OUD.

Establishment of a per oral endoscopic myotomy program at a rural tertiary care center.

This study's purpose is to determine the application and effectiveness of a POEM program in the rural healthcare setting. Achalasia has a substantial impact on the lives of afflicted patients. Traditionally, a Heller myotomy with fundoplication has been the standard of care for treatment. In 2008, the first per oral endoscopic myotomy (POEM) was performed in Japan. Since 2017, our rural healthcare institution has performed approximately 60 POEMs. An IRB approved, single-institution retrospective review of patient outcomes after POEM was performed along with prospective analysis of post-operative surveys. An institutional cost analysis was also performed. Demographic and qualitative variables were measured and included PPI use, a Likert scale of 0-5 for progressively worsening symptoms of heartburn, dysphagia, and regurgitation. In addition, we included a Dysphagia Outcome and Severity Scale. The number of myotomy operations increased from 4.5 per year to 28.8 per year after initiation of the POEM program. Mean Likert scale scores were 0.91, 0.73, and 1 for heartburn, dysphagia, and regurgitation, respectively. 72.5% percent of patients were satisfied with their present condition. 87.5% of patients reported minimal or no dysphagia on the Dysphagia Severity Scale. Intraoperative costs were $2477 for laparoscopic myotomy and $1650 for POEM. The capital expense of the equipment required to perform POEM was $110,232. Average contribution margin per case was $6024. The procedure pays off capital outlay upon completion of the 19th case. This study shows that patients have excellent symptom control after POEM. When compared to the institution's laparoscopic myotomy volume, POEM far surpasses in terms of operative volume and monetary benefit. Examination of these data shows that a rural hospital can successfully employ a state-of-the-art intervention when there is a population in need and an infrastructure in place.