Individual Residents Research Articles

Individual residence and identity theft: how residential characteristics shape exposure and risk of offline and online identity theft victimization

Purpose The purpose of this study is to examine the effect of micro-level place on identity theft victimization. This study uses the 2016 Identity Theft Supplement (ITS) to investigate whether aspects of an individual’s residence affect their likelihood of becoming identity theft victims. Design/methodology/approach The authors conduct logistic regressions of whether a respondent was an identity theft victim in the past year using the following variables as key predictors: number of housing units in a residence, whether the respondent operates a business out of their residence and if residence access is restricted. Findings The results suggest that location influences the likelihood of identity theft to a modest degree though some aspects of location (possibly those related to rewards perceptions) may be more relevant than others. Meanwhile, though location may influence initial target selection, whether someone is victimized may be more dependent on factors such as personal behavior. Originality/value To the best of the authors’ knowledge, this manuscript represents one of the first investigations into the relationship between microlevel place and the incidence of identity theft. Furthermore, it provides evidence that one does exist which bears further inquiry.

EFFECTIVENESS OF VENTILATION CARBON FILTER IN CONTROLLING MICROORGANISMS IN ROOM AIR

The house is a place of residence or shelter for individuals or groups. In general, the house has ventilation, ventilation functions as a rotation or exchange of air in the room. The existence of ventilation is very important for air exchange, but the existing air pollution, including microbes, causes air exchange through ventilation into the house which is not safe for health. So there is a need for filtration so that the polluted air can be filtered. . The purpose of this study was to determine the effectiveness of the use of ventilation carbon filters in controlling microorganisms in room air.This type of research is experimental research with a research design using the Pre and Post Test Only Design .The results showed 1) There was an average decrease in the number of germs in the room by 1412 CFU/m3 or 62%. 2) There is an average decrease in the number of fungi in the room by 17 CFU/m3 or 44%. 3) there is a significant difference in reducing the number of germs in the room air before and after being given a carbon filter ventilation with p-Value = 0.000. 4) There is a significant difference in the reduction of mold numbers in room air before and after being given a carbon filter ventilation p-Value = 0.035. The recommendations given are that it is hoped that the community can use carbon filters as adsorbents for air pollutants that enter the room. Carbon filter ventilation that has been used needs to be washed and activated so that it can adsorb air pollutants more optimally. The room still has to be cleaned regularly to reduce air pollution which poses a risk to the health of occupants.
 

Design and implementation of power management system integrated with cooperative systems for an apartment building

The power management system (PMS) for detached houses has been studied for many years; however, the PMS for apartment buildings (APBs) is not fully understood considering the structures of the APBs. Furthermore, electric vehicle (EV) batteries, photovoltaic (PV) generation, and battery energy storage system (BESS) can be used as distributed energy resources. Therefore, this study proposes an integrated PMS that optimizes the power schedules of individual residents, EV batteries, and common facilities (PV power generation and BESS) in APBs considering the time-of-use pricing policy. To develop the proposed system, a two-stage optimization was adopted using a genetic algorithm. For individual households, the first stage had three objectives: electricity cost, peak power, and user comfort. For the APB, the second stage had two objectives: total electricity cost and total peak power. To evaluate the performance of the proposed system, computational experiments were conducted in three cases: 1) unmanaged schedule, 2) conventional system, and 3) proposed system. For 50- and 100-unit APBs, the proposed PMS had lower total electricity costs (53119 JPY, 106150 JPY) and total peak power demands (184 kW, 366 kW) than the total electricity costs (54744 JPY, 109517 JPY) and total peak power demands (214 kW, 423 kW) of the conventional PMS. Based on a case study that used the proposed two-stage system with different weighting factors, the trade-off relationship among the five objectives of the proposed PMS was obtained. These findings suggest that the all-inclusive power scheduling of the APBs can be managed by dividing the comprehensive demand into individual household and common facility power demands, including cooperative systems. These results provide an important opportunity to advance the understanding of integrated PMS and cooperative systems for APBs. Further research is required to establish the dynamic relationships between households and APBs.

Establishing a Reliable Assessment of the Green View Index Based on Image Classification Techniques, Estimation, and a Hypothesis Testing Route

Sustainable development policies and spatial planning for maintaining greenery are crucial for all major cities in the world, and the measurement of green space indicators in planning practice needs to evolve in response to the demands of the times and technological drivers. This study explores an informal urban green space indicator, the green view index (GVI), which uses the visual perception of an observer to measure the quality of urban space by simulating the pedestrian perspective of the road in street-view image data and then calculating the proportion of vegetation in the road landscape. The GVI is different from macro indicators, such as public recreational green space, forest coverage, and green space rate, which are derived from planning data or remote sensing data in traditional urban planning; it starts from the bottom-up perception of individual residents and is more relevant to their subjective demands. At present, most international cities have made outstanding achievements in controlling public recreational green space, forest coverage, green space rates, and other macrolevel indicators of urban spatial quality; however, with the promotion of the concept of “human-oriented” urban planning, the potential restoration of urban spatial quality at the microlevel is gradually being recognized. To ensure the efficiency and reliability of this study, inspired by computer vision techniques and related GVI studies, a research method based on chromaticity was built to identify the proportions of green vegetation in street view images, and the credibility was improved by eliminating unreliable data. By using this method, we could evaluate a city at an overall scale instead of the previous block scale. The final research result showed that Shenzhen is friendly to human visual senses, and the GVI of the streets in developed areas is generally higher than that in developing areas. The geostatistical analysis of the green viewpoint data provides a more intuitive guide for researchers and planners, and it is believed to inform the planning and design of environmentally friendly, smart, and sustainable future cities.

Analysis of Current Medical Student Mistreatment on the Obstetrics and Gynecology Clerkship [ID: 1342315

INTRODUCTION: At our institution, there are a high proportion of mistreatment reports by medical students stemming from interactions with residents during their obstetrics and gynecology training. There is minimal published data on this issue. This project reviewed and categorized mistreatment reports from medical students during their obstetrics and gynecology rotations to identify factors contributing to medical student mistreatment in this setting and establish a basis for targeted interventions. METHODS: After receiving IRB approval, student responses from post-rotation surveys were compiled from the three most recent academic years. The responses were de-identified and compiled into a database encompassing all student responses to mistreatment questions. The study authors used an existing taxonomy for unprofessional behavior, established by Cullen et al, to classify responses in the database into categories. Up to three categories could be selected per response. RESULTS: 9.2% (34/369) of students documented some form of mistreatment while on their obstetrics and gynecology rotation. Of the responses evaluating individual residents, 2.0% (86/4248) reported mistreatment. Of responses where mistreatment was reported, 48.33% were categorized as “Ineffective or negligent teaching/mentoring,” 25.00% as “Indirect abuse, aggression, or disrespect,” and 21.67% as “Ineffective or incomplete communication.” All of the remaining categories comprised less than 15% of the total. Category proportions were similar when looking at responses related to individual residents and to the rotation overall. CONCLUSION: Most concerns stemmed from perceived neglect from residents and staff, rather than overt bad-acting. Interventions to reduce this type of perceived mistreatment should focus on enhancing student engagement and interaction, effective teaching, and clear communication between students, residents, and staff.

Using cognitive load theory to develop an emergency airway management curriculum: the Queen's University Mastery Airway Course (QUMAC).

Emergency airway management requires the simultaneous coordination of clinical reasoning and therapeutic interventions in the complex and time-sensitive setting of emergency resuscitation. The cognitive demand associated with these situations is invariably high and must be taken into consideration when designing training programs for this core professional competency. The four-component instructional design model (4C/ID), based on cognitive load theory, was used to develop a 1-year longitudinal airway management curriculum for Emergency Medicine residents. The simulation-based curriculum was designed with the goal of facilitating the construction and automation of schemas by individual residents in preparation for the high cognitive demand associated with emergency airway management in the clinical environment.

Development of a COVID-19 vaccine effectiveness and safety assessment system in Japan: The VENUS study.

There are currently no COVID-19 vaccine assessment systems in Japan that allow for the active surveillance of both vaccinated and unvaccinated persons. Herein, we describe the development of Japan's first COVID-19 vaccine effectiveness and safety assessment system with active surveillance capabilities. The Vaccine Effectiveness, Networking, and Universal Safety (VENUS) Study was developed as a multi-source database that links four data types at the individual resident level: Basic Resident Register (base population information), Vaccination Record System (vaccination-related information), Health Center Real-time Information-sharing System on COVID-19 (HER-SYS; information on COVID-19 occurrence), and health care claims data (information on diagnoses, hospitalizations, diagnostic tests, and treatments). These data were obtained from four municipalities. Individual residents were linked across the data types using five matching algorithms based on names, birth dates, and sex; the data were anonymized after linkage. To ascertain the viability of the VENUS Study's database for COVID-19 vaccine assessments, we examined the trends in COVID-19 vaccinations, COVID-19 cases, and polymerase chain reaction (PCR) test numbers. We also evaluated the linkage rates across the data types. Our multi-source database was able to monitor COVID-19 vaccinations, COVID-19 cases, and PCR test numbers throughout the pandemic. Using the five algorithms, the data linkage rates between the COVID-19 occurrence information in the HER-SYS and the Basic Resident Register ranged from 85·4% to 91·7%. If used judiciously with an understanding of each data source's characteristics, the VENUS Study can provide a viable data platform that facilitates active surveillance and comparative analyses for population-based research on COVID-19 vaccine effectiveness and safety in Japan.

Effectiveness of field-exposed attract-and-kill devices against the adults of Popillia japonica (Coleoptera: Scarabaeidae): a study on duration, form and storage.

The Japanese beetle Popillia japonica Newman is an insect pest native to Japan that has spread into North America, the Azores and, recently, into continental Europe. Here, we present a study assessing the effectiveness of a long-lasting insecticide-treated net (LLIN), assembled in semiochemical-baited attract-and-kill devices (A&Ks) as a low environmental impact means to control P. japonica in the field. We compared the attractiveness of three different forms of A&Ks that were left outdoors throughout the summer, and the residence time of P. japonica landing on them. Moreover, we performed a preliminary study testing the effectiveness of new LLINs after storage. Collected data also allowed us to investigate the beetles' diel flight patterns in relation to meteorological conditions. Killing effectiveness of the field-exposed A&Ks declined steadily over the flight season (from 100% to 37.5%) associated with a decrease in residues of α-cypermethrin, the active ingredient in the LLINs. The different A&K forms (pyramidal, octahedral and ellipsoidal) attracted similar numbers of beetles. Individual beetles' residence time ranged from 75 to 95 s and differed slightly between A&K forms. Effectiveness of LLINs decreased by ≈30% after 1 year storage. Based on numbers landing on A&Ks, the beetles' flight activity peaked about 14:30 h and was inversely correlated with relative humidity. This study indicates that semiochemical-baited A&Ks are effective for controlling P. japonica in the field. Because of active ingredient decay, the LLINs should be replaced after 30-40 days of field exposure to ensure that the A&Ks remain fully functional. © 2023 The Authors. Pest Management Science published by John Wiley & Sons Ltd on behalf of Society of Chemical Industry.

Налоговое резидентство физических лиц в России в условиях высокой трансграничной мобильности

The article explores rules on tax residence of individuals as set in the Russian nation legislation and double tax treaties. The author comes to the conclusion that in the context of high cross-border mobility of individuals the current Russian legal regulation of tax residence does not adequately protect the fiscal interests of the state, since it uses a criterion that allows taxpayers to choose if they want to be Russian tax residents or not in the current tax period and lose their tax resident status while maintaining real personal, social and economic ties with the state. At the same time the introduction of new criteria should not be based on blind copying of the experience of foreign countries or the provisions of double tax treaties, and the new rules should use unambiguous wording. In particular, if the terms “availability of a permanent home” or “centre of vital interests” are introduced to national legislation, their meaning should be explicitly defined.

The combined effect of air and transportation noise pollution on atherosclerotic inflammation and risk of cardiovascular disease events

BackgroundAir pollution and noise exposures individually associate with major adverse cardiovascular events (MACE) via a mechanism involving arterial inflammation (ArtI); however, their combined impact on ArtI and MACE remains unknown. We tested whether dual (vs. one or neither) exposure associates with greater ArtI and MACE risk and whether MACE risk is mediated via ArtI. MethodsIndividuals (N = 474) without active cancer or known cardiovascular disease with clinical 18F-FDG-PET/CT imaging were followed for 5 years for MACE. ArtI was measured. Average air pollution (particulate matter ≤ 2.5 μm, PM2.5) and transportation noise exposure were determined at individual residences. Higher exposures were defined as noise > 55 dBA (World Health Organization cutoff) and PM2.5 ≥ sample median. ResultsAt baseline, 46%, 46%, and 8% were exposed to high levels of neither, one, or both pollutants; 39 experienced MACE over a median 4.1 years. Exposure to an increasing number of pollutants associated with higher ArtI (standardized β [95% CI: .195 [.052, .339], P = .008) and MACE (HR [95% CI]: 2.897 [1.818–4.615], P < .001). In path analysis, ArtI partially mediated the relationship between pollutant exposures and MACE (P < .05). ConclusionAir pollution and transportation noise exposures contribute incrementally to ArtI and MACE. The mechanism linking dual exposure to MACE involves ArtI.

Can government subsidies and public mechanisms alleviate the physical and mental health vulnerability of China’s urban and rural residents?

BackgroundPoverty vulnerability has been defined as the likelihood of a family falling into poverty in the upcoming months. Inequality is a major cause of poverty vulnerability in developing countries. There is evidence that establishing effective government subsidies and public service mechanisms significantly reduces health poverty vulnerability. One of the ways to study poverty vulnerability is by using empirical data such as income elasticity of demand to perform the analysis. Income elasticity refers to the extent to which changes in consumers’ income affect changes in demand for commodities or public goods. In this work, we assess health poverty vulnerability in rural and urban China. We provide two levels of evidence on the marginal effects of the design and implementation of government subsidies and public mechanisms in reducing health poverty vulnerability, before and after incorporating the income elasticity of demand for health.MethodsMultidimensional physical and mental health poverty indexes, according to the Oxford Poverty & Human Development Initiative and the Andersen model, were implemented to measure health poverty vulnerability by using the 2018 China Family Panel Survey database (CFPS) as the data source for empirical analysis. The income elasticity of demand for health care was used as the key mediating variable of impact. Our assessment was conducted by a two-level multidimensional logistic regression using STATA16 software.ResultsThe first level regression indicates that the marginal utility of public mechanism (PM) in reducing urban and rural vulnerability as expected poverty on physical and mental health (VEP-PH&MH) was insignificant. On the other hand, government subsidies (GS) policies had a positive suppression effect on VEP-PH&MH to a relatively low degree. The second level regression found that given the diversity of health needs across individual households, i.e., the income elasticity of demand (HE) for health care products, PM and GS policies have a significant effect in reducing VEP-PH&MH in rural and urban areas. Our analysis has verified the significant positive impact of enacting accurate GS and PM policies on effectively reducing VEP-PH&MH in rural as well as urban areas.ConclusionsThis study shows that implementing government subsidies and public mechanisms has a positive marginal effect on reducing VEP-PH&MH. Meanwhile, there are individual variations in health demands, urban-rural disparities, and regional disparities in the effects of GS and PM on inhibiting VEP-PH&MH. Therefore, special consideration needs to be given to the differences in the degree of health needs of individual residents among urban and rural areas and regions with varying economic development. Furthermore, considerations of this approach in the current worldwide scenario are analyzed.

Evaluation of a modernized supported housing intervention for individuals who experience severe and persistent mental illness in Ontario, Canada.

Supported housing approaches that include case management and increased opportunities for independence and personal autonomy for people who are living with severe and persistent mental illness (SPMI) have been found to help reduce hospitalizations and use of the emergency department. What is not fully clear is if these types of supported housing arrangements also influence the use of primary health care and other specialist services. This study uncovered that individuals experiencing SPMI who lived in supported housing used more primary health care and specialist physician services, in the year following transition to this housing arrangement. The findings of this study suggest that supported housing arrangements for people experiencing SPMI may help in improving the personalization of health services for individual residents, including increasing access to both primary health care and specialist services. This is important for nursing practice, as the findings of the study show that supported housing arrangements for people experiencing SPMI may assist in better supporting their complex health care needs. INTRODUCTION: Supported housing for people who are living with severe and persistent mental illness (SPMI) has been found to help reduce hospitalizations and use of the emergency department. What is not fully clear is if these types of supported housing arrangements also influence the use of primary health care and other specialist services. The aim of this study was to compare the use of health services use of individuals with SPMI, before and after transition to the new supported housing program. Using health care administrative databases, a pre-post cohort study was conducted examining the health system use of residents who transitioned from custodial to supported housing arrangements between 2017 and 2019. Individuals with SPMI used more primary health care and specialist physician services after transition to the supported housing model. The results suggest that a supported housing model may be associated with increased usage of outpatient person-centred health services in people experiencing SPMI. The findings of this study suggest that supported housing arrangements for people experiencing SPMI may help in improving the personalization of health services for individual. This is important for nursing practice, as the findings of the study show that supported housing arrangements may assist in better supporting complex health care needs of individuals.

The Influencing Mechanism of Urban Travel Carbon Emissions from the Perspective of Built Environment: The Case of Guangzhou, China

Urban travel is a major component of urban transport, and the total carbon emissions of urban transport can be effectively reduced if the carbon emissions of residents’ travel can be reasonably controlled. Based on the questionnaire data of many different types of residential areas in Guangzhou, the daily travel behaviour of residents was analysed and their travel carbon emissions were calculated. The differences in travel characteristics and travel carbon emissions of residents in different types of residential areas were compared. The influencing factors of residents’ travel carbon emissions were divided into three categories: individual socio-economic factors, built environment, and residents’ travel behaviour. On this basis, a structural equation model is established to study the impact mechanism of residents’ travel carbon emissions. The path relationship between endogenous variables and endogenous variables, as well as the path relationship between exogenous variables and endogenous variables were investigated. The interactions between various influencing factors of residents’ travel carbon emissions were examined. The results show that: (1) there are significant differences in residents’ travel carbon emissions in different types of municipalities. Residents’ travel carbon emissions in Guangzhou are closer to the 60/20 distribution; (2) compared with individual socio-economic factors, the impact of the built environment on travel carbon emissions is more obvious; (3) travel distance and travel mode are the factors that directly affect residents’ travel carbon emissions. Proposals have been made to reduce the carbon emissions of residents travelling.

Impact of Nonconventional Selection by Insecticides on Susceptibility of the Southern House Mosquito,Culex quinquefasciatus

Mosquitoes are an important target of pest control as they vector pathogens that are associated with many debilitating human diseases. Given that mosquitoes have been selected with insecticides for over 100 years, much is known about the development of insecticide resistance associated with targeted application against populations of these insects. However, off-target selection by applications of insecticides in agricultural and residential sites also impacts development of insecticide resistance and is understudied. Similarly, the impact of selecting one life stage of mosquitoes on the insecticide susceptibility of different life stages is largely unknown. Here, we show that susceptibility to chlorantraniliprole, which is applied in rice (Oryza sativa) and sugarcane (Saccharum officinarum) fields in Louisiana, decreased (5.7- to 12-fold) in populations of Culex quinquefasciatus collected from near these fields compared with a reference field strain. In addition, application of bifenthrin by commercial application on an individual residence increased the resistance frequencies to bifenthrin in 5 nearby residential sites. These increased frequencies of resistance, as measured with diagnostic concentrations of bifenthrin, were highly correlated (R2 = 0.92) between larvae and adults, suggesting that selection of adults also confers resistance to larvae. Finally, esterase activities and bifenthrin susceptibilities were moderately correlated (R2 = 0.4 for larvae and 0.52 for adults), suggesting that multiple mechanisms (including metabolism by esterases) were associated with the observed resistance. Results from this study suggest that nonconventional selection by insecticides is a variable to consider when developing management strategies for populations of Cx. quinquefasciatus.

Education Research: Neurology Residents Report Improved Skills After Initiation of a Lumbar Puncture Clinic

Background and Objectives Neurology residents have limited opportunities to perform lumbar punctures (LPs). We hypothesized that establishing a clinic for residents to perform LPs would increase success rates, improve resident comfort with LPs, reduce the need for assistance by attending physicians, and improve patient care. Methods The Vanderbilt University Medical Center neurology residency began a resident LP clinic and measured residents' input and clinical data to see whether the clinic affected resident LP skills. Before and after the launch of LP clinic, neurology residents were invited to complete online surveys at the end of the academic year and during their LP clinic rotation. Completion of the surveys was voluntary and considered consent. The surveys assessed LP attitudes and experience (e.g., confidence with LPs and number performed) and LP clinic procedural data (e.g., LP success rate). Attitudes were measured by assessing confidence; experience by quantifying the number of LPs performed; procedural success was measured by the number of LPs with successful CSF acquisition. Differences in resident attitude and LP outcomes were analyzed using Spearman correlations and logistic regressions. Results Prior to the launch, 15/25 (60% response) residents responded to the clinic survey. After the launch, 6/21 (29%) responded to the first-year follow-up survey and 12/21 (57%) to the second-year follow-up survey. Resident confidence and the number of LPs performed were unchanged. Success rate reported by individual residents increased 15% (p = 0.04), which did not correlate with the overall LP clinic success rate. In the first year of the clinic, 83% of postgraduate year (PGY)3s needed an attending's assistance compared with 29% of PGY4s. In the second year, 44% of PGY3s and 32% of PGY4s needed an attending's assistance. Discussion This structured clinic provided an opportunity for informal resident-to-resident teaching, which may have reduced the need for attending assistance.

“A Proper Direction to Their Places of Abode”: Street Addressing and Wayfinding in England, ca. 1650–1850

Finding one’s way around a town, the house of a friend, or a specific shop, are everyday practices and challenges that involve the application of much implicit knowledge—knowledge of spatial patterns, routes, and directions, for instance, which is often acquired performatively and unconsciously. In eighteenth-century England, rapid urbanization, increased mobility, and intensified commercial exchange aggravated such challenges. This gave rise to various media designed to assist orientation and make local knowledge more readily available to wider audiences, for example, in maps, directories, and guidebooks.One type of information particularly affected by this development was the street address of individual residents and businesses. While up until the beginning of the eighteenth century such directions, as used in advertisements and on letters, tended to be highly specific, detailed, and changeable, over the course of a few decades, they became more standardized and concise. This was closely connected to an increasing tendency to treat addresses as stable and clear-cut pieces of information that could be passed on, published, and retrieved easily. Originally fluid, tacit knowledge was thus transformed into standardized, explicit information, fixed on calling cards and in directories. However, these forms of publication not only served to facilitate social and economic interactions, but they also touched upon sensitive issues of privacy: being easy to find was not necessarily desirable and, in fact, deemed rather risky by some, who consequently tried to keep information about their place of residence or work private.This paper sketches the development of styles and practices of street addressing in England between 1650 and 1850, drawing upon rich source material such as letters, directories, advertisements, and Post Office papers as well as contemporary novels. It serves as a case study of the complex relations between tacit and explicit, private and public knowledge.

Longitudinal Study of Emotional Intelligence, Well-being, and Burnout of Surgical and Medical Residents.

Emotional intelligence (EI) as a concept is becoming increasingly relevant in the healthcare industry. In order to examine the relationship between EI, burnout, and wellness, we administered these measures quarterly in resident physicians and analyzed the variables in each subset to gain insights and understanding of their relationship. In 2017 and 2018, all residents entering the training programs in year one (PGY-1) were administered The Emotional Intelligence Questionnaire - Short Form (TEIQue-SF), The Maslach Burnout Inventory (MBI), and The Physician Wellness Inventory (PWI). The questionnaires were completed quarterly. Statistical analysis included ANOVA and ANCOVA. The overall combined PGY-1 resident year (n = 80) had an EI global trait mean score of 5.47 (SD: 0.59) at the beginning of their first year. The domains of burnout and physician wellness were examined across four different time points during the resident's first year. Domain scores changed significantly over the four time points during the first year. There was a relative 46% increase in exhaustion (P < .001), 48% increase in depersonalization (P < .001), and an 11% decrease in personal achievement (P < .001). Physician wellness domains also changed significantly between time 1 and the end of the year (time 4). There was a relative 12% decrease in career purpose (P < .001), a 30% increase in distress (P < .001), and 6% decrease in cognitive flexibility (P < .001). Each burnout domain and physician wellness domain were highly correlated with emotional quotient (EQ). Emotional quotient was independently assessed with each domain at baseline and with changes overtime. The lowest EQ group reported their distress increased significantly over time (P = .003) and a decline in career purpose (P < .001) and cognitive flexibility (P = .04). The response rate was 100%. Emotional intelligence is associated with well-being and burnout in individual residents; therefore, it is important to identify those who require increased support during residency in order to succeed.

Quality and Health Equity Dashboards for Internal Medicine Residents: Interactive Displays to Promote Systems-Based Practice and Practice-Based Learning and Improvement.

Background Quality measures help identify gaps and disparities in care delivery and prioritize opportunities to improve health. Calls to enhance Systems-Based Practice and Practice-Based Learning and Improvement competencies for residency training cite the need for quality measures for trainees as central to this effort. The authors sought to demonstrate the feasibility of creating a residency program data visualization dashboard to examine individual and program quality measures for an internal medicine residency program within Kaiser Permanente Northern California. Methods An interactive display was developed to allow for easy visualization of quality and operational measures through an iterative design process. The dashboard displays data for individual residents, residency classes (PGY1-3), and the entire program, including quality measures, systems measures, and patient diagnoses. An iterative process continues to improve the functionality and usefulness of the dashboard. Results It is feasible to create a dashboard to visualize individual and program quality measures and health equity measures for a residency program using a learner-centered approach and alignment with institutional goals through collaboration between education and operational teams. Future studies will examine the audit and feedback process, resident perceptions, and changes to patient outcomes. Conclusion Use of dashboards in graduate medical education is feasible and can be used to help residents and residency programs identify gaps in quality of care.

Racial and Sex Disparities in Resident Attrition Among Surgical Subspecialties

Racial and sex disparities are prevalent in surgical trainees. Although retrospective studies on resident attrition have been conducted for individual specialties, this study analyzes racial and sex differences in resident attrition among all surgical subspecialties over an 18-year period. To evaluate the racial and sex differences in resident attrition among surgical specialties over an 18-year period. This was a large, cross-sectional, database study that analyzed program-reported resident censuses (program information, resident demographics, and attrition status) obtained by the Association of American Medical Colleges from 2001 to 2018 for trainees in surgical residency programs. Data were analyzed from March 20, 2021, to June 8, 2022. Demographic trends (including race and ethnicity and sex) for all surgical subspecialty training programs over an 18-year period. Resident attrition includes all-cause withdrawals, dismissals, and transfers to another specialty. Unintended attrition encompasses all withdrawals, dismissals, and transfers except for changing career plans. This study included 407 461 program-reported resident years collected from 112 205 individual surgical residents (67 351 male individuals [60.0%]). The mean percentage of female trainees was 40.0% (44 835) and increased over the study period. Sex disparity remained greatest in orthopedic surgery. Residents who were underrepresented in medicine (URiM) comprised 14.9% (16 695) of all surgical trainees but demonstrated a 2.1% decrease over the study period. Overall attrition rate among all specialties was 6.9% (7759), with an unintended attrition rate of 2.3% (2556). Female residents had a significantly higher relative risk (RR) of attrition (RR, 1.16; 95% CI, 1.11-1.22; P < .001) and unintended attrition (RR, 1.17; 95% CI, 1.08-1.26; P < .001) compared with their male counterparts. URiM residents were at significantly higher RR for attrition (RR, 1.40; 95% CI, 1.32-1.48; P < .001) and unintended attrition (RR, 1.92; 95% CI, 1.75-2.11; P < .001) compared with non-URiM residents. The highest attrition (10.6% [746 of 7043]) and unintended attrition (5.2% [367 of 7043]) rates were in Black/African American residents. The lowest attrition and unintended attrition rates were seen in White residents at 6.2% (4300 of 69 323) and 1.8% (1234 of 69 323), respectively. Black/African American residents were at disproportionate risk for attrition (RR, 1.66; 95% CI, 1.53-1.80; P < .001) and unintended attrition (RR, 2.59; 95% CI, 2.31-2.90; P < .001) compared with all other residents. Orthopedic surgery had the highest attrition (RR, 3.80; 95% CI, 2.84-5.09; P < .001) and unintended attrition (RR, 7.20; 95% CI, 4.84-10.71; P < .001) for Black/African American residents. Results of this cross-sectional study suggest that the percentage of female residents in surgical specialties has improved over the last 18 years, and the percentage of URiM residents has remained relatively unchanged. Risk for attrition and unintended attrition was significantly elevated for female and URiM residents, specifically Black/African Americans. These results highlight current racial and sex disparities in resident attrition and demonstrate the importance of developing strategies to recruit, retain, and support residents.

Supporting a Culture of Wellness: Examining the Utility of the Residency Program Community Well-Being Instrument in the Medical Training and Work Environment.

Physicians are experiencing symptoms of burnout at unprecedented rates. It is essential to assess programmatic factors contributing to physician burnout as actionable items for work climate improvement. Creation of an evidence base of strategies and methods to cultivate a culture of wellness requires iterative assessment, program development and implementation, and evaluation. To serve their function optimally, assessment tools need to be reliable, valid, and sensitive to change. In this Invited Commentary, the authors discuss Vermette and colleagues' report on the Residency Community Well-Being (RCWB) instrument. The authors examine the utility of the RCWB, a novel, validated tool that quantifies the subjective community well-being of an individual residency program and has 3 subscales that measure key aspects of interpersonal interactions among residents, with emphasis on those within the program leadership sphere of influence. The commentary authors recommend further validation of the RCWB, but acknowledge the instrument is a useful contribution to currently available measures in the domains of community well-being, workplace climate, and culture of wellness. Workplace interventions focused on community well-being or culture of wellness are particularly salient ethical and educational priorities for medical training programs. Prioritizing community well-being will help nurture trainees as an investment in the future of medical care, rather than an exploitable resource valued primarily for short-term work demands.