Responsibility For Patient Care Research Articles

Dentists’ Mental Health: Challenges, Supports, and Promising Practices

Objectives: The mental health of dentists, like all health professionals, is a growing concern. The objectives of this study were to identify the mental health challenges experienced by Canadian dentists and to describe the support needs and promising practices to better support them. Methods: This study used a mixed-methods case study design to gather data from semistructured qualitative interviews and a survey for triangulation. Results: Thirty-six dentists and 17 stakeholders participated in the interviews, and 397 dentists participated in the survey. The interview and survey data revealed that dentists have experienced several challenges personally, professionally, and socially. Around 44% of participating dentists experienced a wide range of mental health issues, including depression, anxiety, and posttraumatic stress disorder. Sex/gender shaped the mental health experiences of female dentists, who reported more stress related to caring responsibilities. They had a higher percentage of mental health issues (50%) than men (37%). Caretaking emerged as the main challenge in the social and personal domain, particularly for female dentists in both survey and interview findings. The dentists’ role in practice was one of the most frequently reported professional challenges. While practice owners reported challenges with staff and practice management, associate dentists experienced difficulties with the lack of autonomy and conflicts with office managers and owners. Other challenges reported by participating dentists included patient care responsibilities, loneliness, and isolation. To address these challenges and their impact, dentists and stakeholders identified several support needs and promising practices, including increasing awareness about mental health issues, expanding existing mental health resources, incorporating mental health content in dental education, and encouraging engagement in organized dentistry, particularly for women. Conclusions: The impact of mental health challenges on dentists’ career trajectory and productivity is an ongoing concern in Canada. Gender-specific strategies to support the mental health of dentists should be developed. Knowledge Translation Statement: This study identified the mental health challenges of dentists in Canada to inform the development of interventions and strategies to promote the health and well-being of dentists and dental students. It also highlighted the need for clinicians, students, and individuals in leadership positions in institutions and professional organizations to recognize and consider the working conditions of dentists in various positions to avoid negative consequences on their mental health, reduce the attrition from the professional, and improve patient care outcomes.

The characteristics of general practitioners and geriatricians who take overall responsibility for the care of older patients with multimorbidity

AbstractBackgroundOlder patients with multimorbidity often seek care from multiple health care providers and visit several medical institutions. Having a primary care provider who takes overall responsibility for their care may be beneficial. We conducted a survey to identify the characteristics of general practitioners and geriatricians who frequently assume such responsibility for older patients with multimorbidity.MethodsIn June 2022, we distributed by mail an anonymous questionnaire to 3300 family medicine specialists, primary care‐certified physicians, and geriatric specialists in Japan. We used a four‐point Likert‐type scale to score items related to conditions and patient backgrounds that pose challenges in treatment, key clinical factors, and important clinical strategies. Modified Poisson regression was used to identify factors associated with frequently assuming overall responsibility for medical care.ResultsData from 746 physicians were included in the analysis. Factors associated with frequently assuming overall responsibility for medical care of older patients with multimorbidity included providing inpatient ward care (prevalence ratio [PR] 1.237, 95% CI 1.124–1.362), providing home medical care (PR 1.357, 95% CI 1.225–1.504), frequently treating patients over 90 years old (PR 2.043, 95% CI 1.258–3.318), and the overall score for clinical strategies (PR 1.021, 95% CI 1.010–1.033).ConclusionsGeneral practitioners and geriatricians who frequently assume overall responsibility for the care of older patients with multimorbidity tend to engage significantly in ward and home medical care, often treat patients above 90 years, and employ numerous clinical strategies.

Essential competencies for healthcare chaplains: insights from hiring managers and implications for chaplaincy education

This first-of-its-kind study explored the essential competencies healthcare chaplaincy hiring managers (HCHMs) sought for entry-level healthcare chaplains (HCCs). We conducted qualitative interviews with 16 HCHMs and using reflexive thematic analysis (RTA), developed nine key themes: interpersonal skills, teamwork, knowledge of family and group dynamics, understanding of the healthcare system, professionalism, proficiency in spiritual assessment, effective communication, commitment to lifelong learning, and knowledge of various religious and spiritual beliefs, extending beyond one’s own faith tradition. These themes reflected HCCs roles as healthcare professionals who contribute to patient care, interdisciplinary collaboration, and spiritual leadership responsibilities. The study underscored the need for chaplaincy education to integrate healthcare-specific coursework, interprofessional training, cultural and religious humility, and deeper knowledge of diverse belief systems. Developing and incorporating curriculum standards based on these themes could enhance the readiness of HCCs to deliver comprehensive care and meet the dynamic demands of diverse patient populations within today’s healthcare landscape.

Roles, Responsibilities, and Expectations of Medical Students on Surgical Subinternships: A Modified Delphi Consensus Study.

Surgical subinternships are important rotations for students preparing for a career in general surgery; however, these rotations often vary by institution and service. This modified Delphi study was conducted to reach a consensus set of roles, responsibilities, and expectations of fourth-year medical students on their surgical subinternships. Candidate statements on roles, responsibilities, and expectations of subinterns were categorized into 7 domains: rotation structure, rounding and patient care, operating room conduct, technical skills, knowledge base, clinic, and professionalism. Expert panels were assembled of key stakeholders: program directors, clerkship directors, other education faculty, trainees, and recent subinterns. Three Delphi rounds were conducted from January to April 2023 to reach consensus defined a priori as a Cronbach α ≥ 0.8 and 80% or greater panel agreement. Forty-six expert panelists were recruited to participate in Delphi rounds, with 100%, 95.7%, and 97.8% response rates in the first, second, and third rounds, respectively. By the third round, 67 statements reached consensus as essential roles, responsibilities, and expectations of surgical subinterns. Key themes from these 67 statements included subinterns approximating the role of an intern with respect to work hours, patient care responsibilities, basic technical skills, and knowledge base. Panelists rated rounding and patient care as the most important domain, followed closely by professionalism. Additional key domains for evaluation in descending order were knowledge base, operating room conduct, clinic, and technical skills. By the third round, notable disagreements in the Delphi process included technical skills and rounding and patient care (93.3% and 88.9% agreement, respectively). This study provides a national consensus on core roles, responsibilities, and expectations for medical students completing surgical subinternships. Students can use these recommendations to prepare for subinternships, whereas faculty as well as residents and fellows can use them to evaluate applicants for general surgery residency positions.

Ethics in Primary Health Care: Responsibilities in Patient Care. Bibliographic review

Medical ethics is essential at the first level of care, where doctors must guarantee the autonomy of patients and equity in terms of health care, according to the World Health Organization (WHO), the International Code of Medical Ethics of the World Medical Association (AMM) and the Ministry of Public Health of Ecuador mention that ethical principles must be implemented and guaranteed in the Primary Health Care physician, the objective of this review is to describe the ethical and moral principles that form part of the doctor in Primary Health Care through reviews of updated bibliographies. It was described that the ethical and moral principles of Primary Health Care are benevolence, justice, wisdom and solidarity and within the main bases on which ethics is focused is the doctor-patient relationship that allows clarifying the correct action on health problems.

Rural dyadic collaboration in heart failure

Abstract Background Dyads (patient/care partner) living with heart failure have shared responsibility for patient care. While theoretical and empirical literature regarding heart failure dyadic care is evolving rapidly, sociocultural contexts are unique and affect relationship dynamics. Yet, dynamics and underlying structures of rural dyadic collaboration in heart failure remains unknown. Purpose The purpose of this secondary analysis was to describe the dynamics and underlying structures of dyadic collaboration in heart failure among rural dyads. Methods A semi-structured interview was used to evaluate the acceptability and usefulness of a 12-week problem-solving intervention in addressing dyadic heart failure-related issues and the development of effective management strategies in week 5. Initially, in the qualitative analysis, an adjusted matrix analysis for each rural dyad was used to identify these dyadic issues and strategies. Subsequently, dynamics and underlying structures of collaboration occurring within these dyads in addressing these issues and strategies were analyzed and thematic codes generated. Finally, a multiple correspondence analysis of dyadic collaboration was performed within these thematic codes and a Benzécri equation used to normalize results, helping to determine the underlying structure and variance explained by the model on a Cartesian graph. Results Twenty-eight living in the rural southeastern U.S. were included. Patients were mostly Caucasian (73.3%), female (60%), married (70%), and college-educated (43%), with an average age of 67.7 years. Care partners were primarily women (n = 50%), Caucasian (82.1%), married (89.3%), and high school-educated (46.4%), with an average age of 64.5 years. Using inductive coding, four codes emerged regarding dyadic relational and collaborative aspects between dyads: role awareness, requesting or receiving help, and improving dyadic communication. XLStat was used for a multiple correspondence analysis (Fig. 1), with checking and then normalizing results using the Benzécri equation on R (Fig.2). There were two gender-determined patterns within dyads. In dyads in which the patient was female and the care partner male, communication improved, requests for assistance were verbalized, and there was an improvement in collaborative orientation. However, partners were unaware of their collaborative role. In contrast, when the care partner was a woman and the patient a man, communication and requests for help were implied, and there was no improvement in collaborative orientation. In this situation, partners had full role awareness. Conclusion(s) These findings suggest gender constitutes a key element in communication, verbalization of needs, and collaborative orientation within rural dyads living with heart failure. The importance of gender roles may be useful in designing future dyadic interventions for rural individuals with heart failure and their informal care partners.

Assessing Nursing Students' Knowledge of Sleeve Gastrectomy Effects

This descriptive study assesses the knowledge of gastric sleeve procedures among 55 fourth-year nursing students at the College of Nursing in 2024. Recognizing the crucial role of nurses in managing obesity through surgical interventions, this research aims to identify educational gaps within the nursing curriculum. The students were evaluated using a structured questionnaire focused on their understanding of the procedure's link to obesity factors. Results indicated that the majority of students had a satisfactory knowledge level, with significant mean scores; however, about 25% of the responses—mainly those detailing surgical specifics—showed insufficient knowledge. These findings highlight the need for enhanced educational focus on bariatric surgery in nursing programs to better prepare students for clinical responsibilities in patient care and surgical support. Highlights: Knowledge Level: Majority of students showed good understanding of gastric sleeve procedures. Knowledge Gaps: About 25% lacked detailed surgical knowledge. Educational Implications: Results suggest the need for enhanced bariatric surgery content in nursing curricula. Keywords: Gastrectomy, Obesity, Nursing Education, Bariatric, Knowledge

Ownership of Patient Care: Medical Students’ Expectations, Experiences, and Evolutions Across the Core Clerkship Curriculum

Phenomenon : Ownership of patient care is a key element of professional growth and professional identity formation, but its development among medical students is incompletely understood. Specifically, how attitudes surrounding ownership of patient care develop, what experiences are most influential in shaping them, and how educators can best support this growth are not well known. Therefore, we studied the longitudinal progression of ownership definitions and experiences in medical students across their core clerkship curriculum. Approach : We conducted a series of four longitudinal focus groups with the same cohort of medical students across their core clerkship curriculum. Using workplace learning theory as a sensitizing concept, we conducted semi-structured interviews to explore how definitions, experiences, and influencers of ownership developed and evolved. Results were analyzed inductively using thematic analysis. Findings : Fifteen students participated in four focus groups spanning their core clerkship curriculum. We constructed four themes from responses: (1) students’ definitions of ownership of patient care evolved to include more central roles for themselves and more defined limitations; (2) student conceptions of patient care ownership became more relational and reciprocal over time as they ascribed a more active role to patients; (3) student assessment fostered ownership as an external motivator when it explicitly addressed ownership, but detracted from ownership if it removed students from patient care; and (4) structural and logistical factors impacted students’ ability to display patient care ownership. Insights : Student conceptions of ownership evolved over their core clerkship curriculum to include more patient care responsibility and more meaningful relational connections with patients, including recognizing patients’ agency in this relationship. This progression was contingent on interactions with real patients and students being afforded opportunities to play a meaningful role in their care. Rotation structures and assessment processes are key influencers of care ownership that merit further study, as well as the voice of patients themselves in these relationships.

Personal and work-related factors associated with post-traumatic growth in nurses: A mixed studies systematic review.

Nurses, assuming a wide range of clinical and patient care responsibilities in a healthcare team, are highly susceptible to direct and indirect exposure to traumatic experiences. However, literature has shown that nurses with certain traits developed a new sense of personal strength in the face of adversity, known as post-traumatic growth (PTG). This review aimed to synthesize the best available evidence to evaluate personal and work-related factors associated with PTG among nurses. Mixed studies systematic review. Studies examining factors influencing PTG on certified nurses from all healthcare facilities were included. Published and unpublished studies were identified by searching 12 databases from their inception until 4th February 2023. Two reviewers independently screened, appraised, piloted a data collection form, and extracted relevant data. Meta-summary, meta-synthesis, meta-analysis, as well as subgroup and sensitivity analyses were performed. Integration of results followed result-based convergent design. A total of 98 studies with 29,706 nurses from 18 countries were included. These included 49 quantitative, 42 qualitative, and seven mixed-methods studies. Forty-six influencing factors were meta-analyzed, whereas nine facilitating factors were meta-summarized. A PTG conceptual map was created. Four constructs emerged from the integration synthesis: (a) personal system, (b) work-related system, (c) event-related factors, and (d) cognitive transformation. The review findings highlighted areas healthcare organizations could do to facilitate PTG in nurses. Practical implications include developing intervention programs based on PTG facilitators. Further research should examine the trend of PTG and its dynamic response to different nursing factors. Research on trauma-focused therapies targeting nurses' mental health is lacking. Therefore, findings from this review could inform healthcare organizations on the PTG phenomenon and developing support measures for nurses through healthcare policies and clinical practice.

Pharmacist-prescriber collaborative models of care for opioid use disorder: an overview of recent research.

Collaborative models of care where pharmacists work alongside physicians have been developed for a range of physical health conditions, with benefits including improved patient outcomes and increased access to ongoing care. Opioid agonist treatment (methadone and buprenorphine) is a clinically effective and cost-effective treatment for opioid use disorder that is under-utilized in many countries due to a shortage of prescribers. In recent years, there has been increased interest in the development of collaborative models that utilize pharmacists to overcome barriers to treatment. In this article, we present a narrative review to synthesise recent work in this rapidly developing area. Two key aspects of opioid agonist treatment were identified: Collaborative models have utilized pharmacists to facilitate buprenorphine induction, and collaborative models provide increased capacity for delivering ongoing care in a variety of settings and patient groups where prescriber access is limited. Pharmacists have undertaken direct patient care responsibilities with varying degrees of autonomy, with benefits including a reduction in prescriber workload, and improvements in treatment retention and continuity of care. Collaborative models in which pharmacists are responsible for buprenorphine induction and ongoing management with methadone and buprenorphine have been shown to reduce demands on prescribers while improving or maintaining patient outcomes, and appear feasible and acceptable in a wide range of outpatient settings.

Effects of Telemedicine on Informal Caregivers of Patients in Palliative Care: Systematic Review and Meta-Analysis.

Telemedicine technology is a rapidly developing field that shows immense potential for improving medical services. In palliative care, informal caregivers assume the primary responsibility in patient care and often face challenges such as increased physical and mental stress and declining health. In such cases, telemedicine interventions can provide support and improve their health outcomes. However, research findings regarding the use of telemedicine among informal caregivers are controversial, and the efficacy of telemedicine remains unclear. This study aimed to evaluate the impacts of telemedicine on the burden, anxiety, depression, and quality of life of informal caregivers of patients in palliative care. A systematic literature search was conducted using the PubMed, Embase, Web of Science, CENTRAL, PsycINFO, CINAHL Plus with Full Text, CBM, CNKI, WanFang, and VIP databases to identify relevant randomized controlled trials published from inception to March 2023. Two authors independently screened the studies and extracted the relevant information. The methodological quality of the included studies was assessed using the Cochrane risk-of-bias tool. Intervention effects were estimated and sensitivity analysis was conducted using Review Manager 5.4, whereas 95% prediction intervals (PIs) were calculated using R (version 4.3.2) and RStudio. A total of 9 randomized controlled trials were included in this study. The meta-analysis indicated that telemedicine has reduced the caregiving burden (standardized mean differences [SMD] -0.49, 95% CI -0.72 to -0.27; P<.001; 95% PI -0.86 to -0.13) and anxiety (SMD -0.23, 95% CI -0.40 to -0.06; P=.009; 95% PI -0.98 to 0.39) of informal caregivers; however, it did not affect depression (SMD -0.21, 95% CI -0.47 to 0.05; P=.11; 95% PI -0.94 to 0.51) or quality of life (SMD 0.35, 95% CI -0.20 to 0.89; P=.21; 95% PI -2.15 to 2.85). Although telemedicine can alleviate the caregiving burden and anxiety of informal caregivers, it does not significantly reduce depression or improve their quality of life. Further high-quality, large-sample studies are needed to validate the effects of telemedicine. Furthermore, personalized intervention programs based on theoretical foundations are required to support caregivers.

Enhancing availability of services to control hypertension through a team-based care approach that includes pharmacists

BackgroundPrimary care physician (PCP) shortages are expected to increase. The Michigan Medicine Hypertension Pharmacists’ Program uses a team-based care (TBC) approach to redistribute some patient care responsibilities from PCPs to pharmacists for patients with diagnosed hypertension. ObjectiveThis evaluation analyzed whether the Michigan Medicine Hypertension Pharmacists’ Program increased the availability of hypertension management services and described facilitators that addressed barriers to program sustainability and replicability. MethodsWe conducted a retrospective observational study that used a mixed methods approach. We examined the availability of hypertension management services using the number of pharmacists’ referrals of patients to other services and the number of PCP appointments. We analyzed qualitative interviews with program staff and site-level quantitative data to examine the program’s impact on the availability of services, the impact of TBC that engaged pharmacists, and program barriers and facilitators. ResultsPatients who visited a pharmacist had fewer PCP visits over 3- and 6-month periods compared to a matched comparison group that did not see a pharmacist and were 1.35 times more likely to receive a referral to a specialist within a 3-month period. Support from leaders and physicians, shared electronic health record access, and financial backing emerged as leading factors for program sustainability and replicability. ConclusionAdding pharmacists to the care team reduced the number of PCP appointments per patient while increasing the availability of hypertension management services; this may in turn improve PCPs’ availability. Similar models may be sustainable and replicable by relying on organizational buy-in, accessible infrastructure, and financing.

Umbrella Review: Stress Levels, Sources of Stress, and Coping Mechanisms among Student Nurses.

Prelicensure nursing students face significant stress from their education and clinical placements, highlighting the crucial need for the development of effective coping mechanisms with which to manage both academic and clinical responsibilities, ultimately enhancing the wellbeing and academic performance of these students. This umbrella review aims to evaluate and synthesize existing review articles that examine stress levels and coping mechanisms among student nurses during their education and training. Five databases (PsycINFO, PubMed, CINAHL, Scopus and Web of Science) were searched for review articles published from 2010 onwards. This review includes twelve articles, encompassing 189 studies. The review findings demonstrate that student nurses experience moderate-to-high levels of stress during their nurse education. Major sources of stress include academic demands, patient care responsibilities, and interactions with nursing staff and faculty. Commonly utilized coping skills involve problem-solving behaviors, transference, and maintaining an optimistic outlook. Given the adverse consequences of stress, nurse educators play a critical role in the development of strategies with which to reduce stress and enhance coping skills among student nurses. This study was not registered.

Peer support-based online education, burden of care and quality of life among family caregivers of patients with leukaemia: non-randomised clinical trial

ObjectiveThe responsibility of caring for patients with leukaemia places a heavy burden on family caregivers (FCs) and negatively impacts their quality of life (QoL). This study aimed to investigate the...

The 6 degrees of curriculum integration in medical education in the United States

Despite explicit expectations and accreditation requirements for integrated curriculum, there needs to be more clarity around an accepted common definition, best practices for implementation, and criteria for successful curriculum integration. To address the lack of consensus surrounding integration, we reviewed the literature and herein propose a definition for curriculum integration for the medical education audience. We further believe that medical education is ready to move beyond “horizontal” (1-dimensional) and “vertical” (2-dimensional) integration and propose a model of “6 degrees of curriculum integration” to expand the 2-dimensional concept for future designs of medical education programs and best prepare learners to meet the needs of patients. These 6 degrees include: interdisciplinary, timing and sequencing, instruction and assessment, incorporation of basic and clinical sciences, knowledge and skills-based competency progression, and graduated responsibilities in patient care. We encourage medical educators to look beyond 2-dimensional integration to this holistic and interconnected representation of curriculum integration.

Factors Associated with Burnout Syndrome among Clinical Medical Students at Chonburi Hospital, Thailand

Objective: Burnout syndrome causes chronic fatigue, loss of motivation, despair, decreased work performance, and depression. Clinical medical students risk developing burnout syndrome due to long-term learning pressure, responsibilities for patient care and night shifts. This study aimed to examine the factors associated with burnout syndrome among clinical medical students at Chonburi Hospital.Material and Methods: A cross-sectional study was conducted from July 2022 and January 2023. Data were collected using the Maslach Burnout Inventory General Survey among 106 medical students. Descriptive statistics, chi-square, ANOVA, and the independent t-test were used to investigate the association among variables.Results: Severe burnout syndrome was not found among clinical medical students. High emotional exhaustion was the most common burnout symptom among these medical students (53.8%). While 27.3% had high depersonalization, no medical students had low personal accomplishment. The factor related to high emotional exhaustion was 4th-year medical students. At the same time, the factors associated with high depersonalization were fourth-year medical students, males, and low accumulated grade point averages (GPAX).Conclusion: The prevalence of severe burnout was not found among clinical medical students at Chonburi Hospital. However, males, fourth-year medical students, and low GPAX were risk factors for burnout symptoms. Therefore, screening, monitoring, and providing help to these at-risk medical students to reduce their chances of severe burnout should be encouraged.

Alone yet accountable, the unseen buffers: A qualitative study of nurses' experiences working in home care during the COVID-19 pandemic.

Norwegian society's resilience during the COVID-19 pandemic resulted in low mortality rates and moderate economic decline. The accessible primary healthcare system played a vital role in this, especially in the care of elderly and chronically ill patients. However, nurses in home care experienced emotional burdens, ethical dilemmas and limited access to protective equipment. These challenges were overshadowed by media coverage of hospital struggles, and municipal home care services were oddly absent from post-pandemic reports. This research therefore aimed to explore and describe how nurses experienced working in home care during the pandemic. We designed a qualitative study and conducted semi-structured interviews with nine home care nurses from different municipalities in Southeast Norway. Systematic text condensation inspired by Malterud was employed for data analysis. Nurses' experiences were described through two categories: 'adapting approaches' and 'adapting work practices'. The results showed how nurses often felt alone while simultaneously shouldering a significant responsibility for patients facing a novel and unfamiliar illness. The pandemic necessitated treating patients in their own homes to minimise infection risks, intensifying the nurses' treatment responsibilities. Furthermore, limited access to medical expertise and physical separation from management due to remote work accentuated feelings of isolation and amplified the nurses' responsibility for patient care. Additionally, the nurses encountered frequent changes in work routines, demanding adaptability. This study underscores the significant role of home care nurses, who, despite feeling professionally isolated and unsupported, demonstrated impressive adaptability. They served as a crucial buffer in the healthcare system, ensuring vulnerable individuals received essential care. This highlights the importance of a robust primary healthcare system with a skilled nursing workforce that can work autonomously, shoulder responsibility, and make clinical decisions, even when medical expertise is less readily available. It also reminds us that healthcare preparedness depends on collaborative efforts across all sectors.

Re-conceptualizing medical education in the post-COVID era

Purpose The COVID-19 pandemic has forced changes in the delivery of medical education. We aimed to explore these changes and determine whether they will impact the future of medical education in any way. Methods We invited leaders in medical education from all accessible US-based medical schools to participate in an online individual semi-structured interview. Results Representatives of 16 medical schools participated. They commented on the adequacy of online education for knowledge transfer, and the logistical advantages it offered, but decried its negative influence on social learning, interpersonal relationships and professional development of students, and its ineffectiveness for clinical education. Most participants indicated that they would maintain online learning for didactic purposes in the context of flipped classrooms but that a return to in-person education was essential for most other educational goals. Novel content will be introduced, especially in telemedicine and social medicine, and the students’ roles and responsibilities in patient care and in curricular development may evolve in the future. Conclusions This study is the first to document the practical steps that will be adopted by US medical schools in delivering medical education, which were prompted and reinforced by their experience during the COVID-19 pandemic.

P178: Scope of post-diagnostic dementia care by Japanese primary care clinics using team-based care models

Objective:Primary care clinics (PCCs) in Japan have acquired the capacity for screening and diagnosing dementia in its early stage. They face challenges in accommodating the complex care needs of people with early-stage dementia in collaboration with other healthcare providers in the community. The study aims were; 1) to classify team-based care models of PCCs for post-diagnostic care for people with early-stage dementia in Japan’s Community-based Integrative Care System and 2) to compare the scope of care in each model.Methods:We conducted a cross-sectional postal survey to certified Dementia Support Doctors working in PCCs in Tokyo. To classify team-based care models, the questionnaire asked about the members, roles, and collaboration of the community-wide care team for early-stage dementia in which participants’ PCCs were involved. We gathered information on care provision across seven domains that PCCs offered for people with early-stage dementia. Three-step latent class analysis was performed to classify models and analyze differences in the proportions of care provision in each domain. The Tokyo Metropolitan Institute for Geriatrics and Gerontology institutional review board approved the study.Results:From the 188 responses, PCCs’ team practices were categorized into three classes, which we named “co-managed,” carved-out,” and “stand-alone” models. While the first two ran an extended care team through in-person communication across facilities in the community, the last applied a minimal team approach with limited and indirect external interaction. The “co-managed” and “carved-out” models were distinguished by how team members shared decision-making responsibilities for patient care. Maximum likelihood estimation grouped 46.6%, 32.8%, and 20.6% of the PCCs into each model in the above order. The three models significantly differed in the proportions of care provision in five of seven domains. The proportions in each domain were the highest for the “co-managed” model (60.7-100%), followed by the “carved-out” (46.2- 98.2%) and “stand-alone” (25.7-88.6%) models.Conclusion:PCCs in Japan’s Community-based Integrative Care System formed three models of post- diagnostic support for people with early-stage dementia. Considering the application of the team approach and the breadth of care provision, either “co-managed” or “carved-out” models are recommended with available community resources in mind.

Stereotype Threat and Gender Bias in Internal Medicine Residency: It is Still Hard to be in Charge

BackgroundDespite similar numbers of women and men in internal medicine (IM) residency, women face unique challenges. Stereotype threat is hypothesized to contribute to underrepresentation of women in academic leadership, and exploring how it manifests in residency may provide insight into forces that perpetuate gender disparities.ObjectiveTo quantify the prevalence of stereotype threat in IM residency and explore experiences contributing to that stereotype threat.DesignWe used a mixed methods study design. First, we surveyed IM residents using the Stereotype Vulnerability Scale (SVS) to screen for stereotype threat. Second, we conducted focus groups with women who scored high on the SVS to understand experiences that led to stereotype threat.ParticipantsThe survey was sent to all IM residents at University of California, San Francisco (UCSF), in September–November 2019. Focus groups were conducted at UCSF in Spring 2020.ApproachThe survey included an adapted version of the SVS. For focus groups, we developed a focus group guide informed by literature on stereotype threat. We used a thematic approach to data analysis. The mixed methods design enabled us to draw metainferences by integrating the two data sources.Key ResultsSurvey response rate was 61% (110/181). Women were significantly more likely than men to have a score indicating stereotype threat vulnerability (77% vs 0%, p < 0.001). Four themes from focus groups characterized women’s experiences of gender bias and stereotype threat: gender norm tension, microaggressions and sexual harassment, authority questioned, and support and allyship.ConclusionsGender-based stereotype threat is highly prevalent among women IM residents. This phenomenon poses a threat to confidence and ability to execute patient care responsibilities, detracting from well-being and professional development. These findings indicate that, despite robust representation of women in IM training, further attention is needed to address gendered experiences and contributors to women’s vulnerability to stereotype threat.