Uniformed Services University Research Articles

A Scalable Advising Model for Part-Time, Distant Learners in Graduate Health Professions Education Programs

Abstract Problem There is a need within graduate health professions education (HPE) programs to align advising practices to support an increasing number of working adult learners, especially those studying part-time and from remote locations. Despite the recognized importance of the advisor-advisee relationship in graduate learner success, many advisors lack formal training and have to manage multiple completing priorities. Furthermore, a lack of established evidence-based practices for graduate HPE advising has left each program navigating advising independently. Approach The Department of Health Professions Education, Uniformed Services University, established a small cadre of faculty to serve as academic advisors (n = 7) in August 2018. This cadre uses an advising model based on 5 advising practices, called TOTAL Advising– train the advisors, onboard the learners, touch base frequently, annually review learners, and learner review. These advising practices are meant to provide a wrap-around support system to ensure learners feel empowered to fully engage in the program, while managing the demands of their personal and professional lives. TOTAL Advising provides the framework needed to achieve 3 guiding beliefs: each learner is capable of completing the program, fostering community, and providing clear communication. Outcomes Between May 2020-May 2024, learners who completed a degree (n = 21) were interviewed about their advising experiences by a program evaluator after they graduated. The themes observed from these reflect the program’s 3 guiding beliefs. Additionally, from May 2018–May 2024, of the 574 learners who enrolled in the program, 568 (99%) graduated with a certificate or degree, only 6 (1%) were disenrolled. Next Steps The next steps for TOTAL Advising involve a comprehensive evaluation of the effectiveness of the training program for advisors and collaborating with other graduate HPE programs to share best practices in advising, discuss emerging challenges, and shape advising practices in the broader HPE community.

Abstract B020: DNA methylation and pancreatic cancer in select gene promoter regions: A repeated measures case-control study of US military service members

Abstract Introduction: Pancreatic cancer (PC) is a devastating disease, its etiology is not fully understood, and there is a paucity of non-invasive biomarkers for early diagnosis. While DNA methylation (DNAm) holds promise, associations between DNAm and PC risk are poorly understood, especially regarding temporal changes in associations. Therefore, we aimed to evaluate potential associations between DNAm in pre-diagnostic serum on 9 genes (BNIP3, CDKN1C, CLDN4, LCN2, p16, RASSF1, SFN, SPARC, and TFPI-2) and 2 repetitive elements (Alu and LINE-1) and PC risk in a US Department of Defense cohort. Methods : The study population included 82 PC cases, diagnosed 1991 - 2007, and 229 controls individually- matched on age (within 5 years), sex, race, and serum draw time period. Cases had up to 3 pre- diagnostic serum samples. Controls had 1 serum sample collected 0-10 years before their selection date (date of case diagnosis). DNA was extracted from serum and the percentage of cytosines at a given CpG site that were methylated was quantified via Pyrosequencing. For serum samples within a time window (<2, 2-<5, and 5-10 years pre-diagnosis), we computed odds ratios (ORs) and 95% confidence intervals (95% CIs) for the association of each CpG site with PC risk (66 sites in total across all genes and repetitive elements) with conditional logistic regression models. DNAm was evaluated as both a binary variable and a continuous variable. Results : In samples collected 5-10 years before diagnosis, those with no DNAm (0% DNAm) had increased odds of PC compared to those with DNAm (>0% DNAm) in the promoter region of BNIP3 (Chr10:131982293 OR, 95% CI: 5.63, 1.16 – 27.28) and those with lower DNAm (<median) had increased odds of PC compared to those with higher DNAm (≥median) in the promoter regions of CDKN1C (Chr11:2886398 OR, 95% CI: 4.07, 1.16 – 14.31; Chr11:2886388 OR, 95% CI: 3.51, 1.24 – 9.96) and RASSF1 (Chr3:50340841 OR, 95% CI: 3.98, 1.15 – 17.45). Similarly, in samples collected 2 - <5 years before diagnosis, lower DNAm (<median) was associated with increased odds of PC compared to those with higher DNAm (≥median) in the promoter region of TFPI-2 (Chr7:93890717 OR, 95% CI: 3.82, 1.20 – 12.15). In models with DNAm as a continuous measure and in samples collected <2 years before diagnosis, a 1% increase in DNAm in the promoter region of SFN was associated with increased odds of PC (Chr1:26863188 OR, 95% CI: 1.23, 1.01 – 1.51). There was no evidence of associations between DNAm on Alu, CLDN4, LCN2, LINE-1, p16, or SPARC and PC risk. Conclusions : Our findings of increased risk of PC associated with lower DNAm on BNIP3, CDKN1C and TFPI-2 and higher DNAm on SFN genes suggest there may be molecular patterns occurring prior to PC diagnosis that could be considered further for developing non-invasive biomarkers for early diagnosis of this aggressive carcinoma. The opinions and assertions expressed herein do not reflect the official policy or position of the Uniformed Services University, the Department of Defense, or the National Cancer Institute. Citation Format: Jordan McAdam, Ruth M Pfeiffer, Alexander P Keil, Ann Meyer, Anwar E Ahmed, Dechang Chen, Jennifer Rusiecki. DNA methylation and pancreatic cancer in select gene promoter regions: A repeated measures case-control study of US military service members [abstract]. In: Proceedings of the AACR Special Conference in Cancer Research: Advances in Pancreatic Cancer Research; 2024 Sep 15-18; Boston, MA. Philadelphia (PA): AACR; Cancer Res 2024;84(17 Suppl_2):Abstract nr B020.

Optimizing e-Learning in CPD: Preferences and Perceptions of Health Professionals.

Continuing professional development for health professionals increasingly relies on e-learning. However, there is insufficient research into the instructional strategies health professionals prefer to engage with in e-learning. An empirical study was undertaken to answer the research question: What instructional strategies do learners prefer in e-learning modules to improve their learning experience? The Department of Health Professions Education at the Uniformed Services University of Health Sciences developed six, stand-alone, self-paced modules for health professionals focusing on education and leadership. The module evaluation survey consisted of six Likert scale questions and two open-ended questions. Responses from these anonymized module evaluations from 2019 to 2022 were analyzed. Descriptive statistics for the Likert scale questions were calculated. Responses to the two open-ended questions were compiled and analyzed thematically. All survey respondents found the content of the modules helpful and met their stated learning objectives. A majority (94%) agreed or strongly agreed that readings and videos increased their knowledge in the topic area and that quizzes effectively strengthened their understanding of the topics. Four themes emerged from the qualitative data: pedagogical strategies, technology issues, feedback and interaction, and transfer of learning. This study foregrounds the voice of the learner, which emphasizes health professionals' preference for instructional strategies that align with their needs as adult learners. The findings highlight the value of content relevance, expert creation, and authentic examples in enhancing learner satisfaction.

Fetal alcohol spectrum disorders prevention and clinical guidelines research - workshop report

It is estimated that up to 1 in 20 people in the United States may have a fetal alcohol spectrum disorder (FASD), or the array of physical, cognitive, emotional, and social disorders caused by exposure to alcohol during prenatal development (May et al., JAMA 319:474–82, 2018). While this condition is present in a broad range of individuals and families, it has not previously been examined in the military community, where cultural factors including an increased prevalence of alcohol misuse may pose a unique set of challenges (Health.mil, Alcohol misuse, 2024).The Uniformed Services University of the Health Sciences (USUHS), in conjunction with FASD United, hosted the second annual Workshop on Fetal Alcohol Spectrum Disorders Prevention and Clinical Guidelines Research on 20 September 2023 in Washington, DC. Organized as part of a four-year, federally-funded health services research initiative on FASD in the U.S. Department of Defense (DoD) Military Health System (MHS), the workshop provided a forum for exploring the initiative’s focus and progress; examining current knowledge and practice in the research and clinical spheres; and identifying potential strategies to further improve prevention, screening, diagnosis, interventions, and family support. Building off of the 2022 workshop that covered the state of the science surrounding prenatal alcohol exposure and FASD, the 2023 focused primarily on FASD and efforts aimed at identification and management (Koehlmoos et al., BMC Proc 17 Suppl 12:19, 2023). One hundred and thirty attendees from academia, healthcare, federal agencies, and patient advocacy organizations gathered to share research findings; learn from lived experiences; and discuss initiatives to advance research, screening, and services for at-risk pregnant women as well as families and caregivers supporting individuals with FASD.

The Military Medicine Leadership Life Cycle: A Model for Longitudinal Leadership Development in Medicine-Undergraduate and Graduate Medical Education.

Physicians must be leaders more than ever with innumerable challenges. Despite this need, there is a paucity of consistent leadership development (LD) from medical student to staff physician. Military medicine has additional challenges-working within a large health care organization, constant turnover, working in a variety of contexts-that make the need for LD even more pressing. The purpose of this paper is to describe the LD life cycle for military undergraduate and graduate medical education (UME and GME), providing examples for other organizations while identifying steps to meet the future needs in military medicine. The Health Professions Scholarship Program produces over 75% of graduates for military medicine each year. Yet, since learners are dispersed throughout civilian medical schools any LD results in a heterogeneous experience. Uniformed Services University has a 4-year LD program required for all students as well as other opportunities for leadership professional growth. Military GME programs are unique, requiring a military unique curriculum to prepare graduates for their initial assignments. Military unique curriculum vary, but include clinical topics relevant to military medicine as well as leadership. There is no Military Healthcare System-wide leadership curriculum used by everyone at this time. Based on these UME and GME approaches to LD, there have been multiple lessons learned formed on the authors experience and published literature: learners do not typically see themselves as leaders; learners want applicable curriculum with less lecturing and more application and discussion; programs are often siloed from one another and sharing curriculum content does not typically occur; no one-size-fits-all model. On the basis of the lessons learned and the current state of UME and GME leadership education, there are 5 recommendations to enhance UME and GME leadership programs: (1) develop a Health Professions Scholarship Program Leadership Curriculum; (2) develop a MHS GME Leadership Curriculum; (3) integrate UME and GME Leadership Curricula; (4) develop faculty to teach leadership; and (5) conduct research on UME and GME in military and share lessons learned. We suggest a roadmap for strengthening LD within military medicine and civilian institutions.

Improved Casualty Depiction System for Simulated Mass Casualty Exercises.

Assessing military medical teams' ability to respond to large-scale mass casualty (MASCAL) events has become a priority in preparing for future conflicts. MASCAL exercises rely on large numbers of simulated patients with limited medical training. Role-players must be appropriately prepared to ensure that medical exercises adequately assess the expected capabilities of military medical units. The Uniformed Services University of the Health Sciences (USUHS) has evaluated future military providers for decades using a large-scale, multiday, immersive simulation called Bushmaster. Despite a robust casualty training system, the fidelity of the portrayals remained limited. Through collaboration with national military medical experts, a comprehensive casualty depiction system was developed. This system relied on structured casualty cards linked to time-based illness scripts. Structured casualty cards included an appropriate balance of disease non-battle injuries and trauma, included multipatient presentations based on shared events (i.e., multiple injured personnel due to an aircraft crash), normal and pathologic combat stress, population/unit considerations, requirements for different roles within the medical unit, and expected clinical outcomes. Illness scripts, supplemented by video guides, included time-based courses of illness/injury and prescribed responses to different typical treatments. This system was piloted during an annual MASCAL exercise (Operation Bushmaster) at USUHS. Clinical faculty were queried on the fidelity of this new system while role-players were evaluated on feasibility. Three hundred casualty cards linked to 49 illness scripts were created, peer-reviewed, and piloted at Bushmaster. A total of 170 military members with limited medical training portrayed simulated patients utilizing the new casualty depiction system. Clinical faculty members strongly agreed that the improved casualty depiction system improved the realism of individual patient presentations (96%). Eighty-three percent of role-players strongly agreed that the casualty depiction system was easy to understand. This improved casualty depiction system was a feasible approach to enhance the fidelity of a MASCAL exercise. It has since been shared with military medical units around the globe to assist with their MASCAL exercises, making future multisite evaluations of this casualty depiction system possible.

Multicenter, randomized, controlled comparative-effectiveness study comparing virtual reality to sedation and standard local anesthetic for pain and anxiety during epidural steroid injections

BackgroundThe main objective of this study was to determine whether virtual reality (VR) reduces procedure-related pain and other outcomes for epidural steroid injections (ESI). Randomized controlled study was undertaken in academic centers in the U.S. and Thailand where 146 patients with lumbosacral radiculopathy undergoing an ESI were allocated to immersive VR with local anesthetic, sedation with midazolam and fentanyl + local anesthetic, or local anesthetic alone.The primary outcome was procedure-related pain recorded on a 0-10 scale. Other immediate-term outcome measures were pain from a standardized subcutaneous skin wheal, procedure-related anxiety, ability to communicate, satisfaction, and time to discharge. Intermediate-term outcome measures at 4 weeks included back and leg pain scores, function, and success defined as a >2-point decrease in average leg pain coupled with a score >5/7 on a Patient Global Impression of Change scale. FindingsProcedure-related pain scores with both VR (mean 3·7 (SD 2·5)) and sedation (mean 3·2 (SD 3·0)) were lower compared to control (mean 5·2 (SD 3·1); mean differences -1.5 (-2.7, -0.4) and -2.1 (-3.3, -0.9), respectively), but VR and sedation scores did not significantly differ (mean difference 0.5 (-0.6, 1.7)). Among secondary outcomes, communication was decreased in the sedation group (mean 3·7 (SD 0·9)) compared to the VR group (mean 4·1 (SD 0·5); mean difference 0.4 (0.1, 0.6)), but neither VR nor sedation was different than control. The trends favoring sedation and VR over control for procedure-related anxiety and satisfaction were not statistically significant. Post-procedural recovery time was longer for the sedation group compared to both VR and control groups. There were no meaningful intermediate-term differences between groups except that medication reduction was lowest in the control group. InterpretationVR provides comparable benefit to sedation for procedure-related pain, anxiety and satisfaction, but with fewer side effects, superior communication and a shorter recovery period. FundingFunded in part by grants from MIRROR, Uniformed Services University of the Health Sciences, U.S. Dept. of Defense, grant # HU00011920011. Equipment was provided by Harvard MedTech, Las Vegas, NV

Experiences of Deployed Physicians in Support of Operation Allies Refuge/Operation Allies Welcome: Lessons to Inform Improvements in Training.

Stability operations, including humanitarian assistance and disaster relief missions, are key functions of U.S. Military medicine and the Military Medical Humanitarian Assistance Course (MMHAC) is a 2-day course widely used to prepare military medical personnel for such missions. It focuses on caring for those most vulnerable in the wake of disasters, particularly children. The large-scale humanitarian deployment of military medical providers in support of Operation Allies Welcome/Operation Allies Refuge (OAW/OAR) presents an opportunity to evaluate the preparedness of these providers to care for the needs of the Afghan travelers, so we explored the experiences of military medical providers deployed in support of OAW/OAR to inform improvements in the MMHAC. We conducted a qualitative study of military medical providers who were deployed in support of OAW/OAR using a series of three virtual focus groups. Focus group questions were structured around the main topics covered in the MMHAC (patient care, ethical considerations, logistical concerns, and preventive and public health) and explicitly asked about adaptive leadership challenges faced and strategies used to overcome them. We analyzed transcripts using inductive thematic analysis within a constructivist paradigm, with adaptive leadership as a sensitizing concept. The study was approved by the Institutional Review Board of Uniformed Services University. We constructed 4 themes from participant responses, each addressing challenges that medical providers faced during their mission: (1) Medical providers navigated tension between medical and public health priorities and military mission priorities; (2) Chronic and complex care needs posed unique challenges for medical personnel; (3) Challenges in patient care were compounded by logistical and system-based barriers; and (4) Cultural barriers led to ethical dilemmas that physicians felt inadequately prepared to handle, most notably with respect to gender-related concerns. Within each theme, participants described which aspects of MMHAC training were most helpful and which areas were inadequate. Physicians found the OAR/OAW mission meaningful but also identified challenges related to medical care provision, public health, logistics, and ethical dilemmas that hindered their ability to carry out their medical mission. Lessons learned from OAW/OAR highlight several areas in which the MMHAC training could be augmented and improved to further mitigate these challenges.

The Power of Faculty Development: The Impact on Teaching a Procedural Skill Framework.

Teaching outpatient procedures is a skill often overlooked in faculty development. This oversight may lead to faculty employing a haphazard approach. Competency in procedural skills is inherent, and acquiring proficiency in procedural skills is necessary across all medical specialties, with some centers moving towarda blended simulation-based approach rather than the traditional Halstedian "see one, do one, teach one" mantra. While both formats have their pros and cons, they share the unifying concept of performance-based assessments and a standardized method for teaching procedures, which has typically been lacking a formal framework. This study aimed to implement and evaluate the impact of teaching an educational technique in a multidisciplinary faculty education workshop about the Sawyer framework for psychomotor skill acquisition. An interactive 90-minute workshop through the Uniformed Services University Faculty Development Program was developed and presented from February 2021 to October 2023 at multiple military treatment facilities. Participants enrolled in the workshop either by online registration or by walking in on the day of the workshop. A postworkshop survey was collected voluntarily. Through the survey, participants self-evaluated their current teaching strategy and made changes to their future strategy based on the framework they learned during the workshop. This was a mixed methods approachwith quantitative survey data that were analyzed using Microsoft Excel (Microsoft Corporation, Redmond, WA) and qualitative data through thematic analysis using a constructivist inductive approach. There were 52 sessions with a total of 570 participants across 22 unique specialties. The response rate was 50%. Before the workshop, 22% of responding participants had no teaching strategy, and 49% had a partial but not explicit strategy for teaching. After the workshop, 89% of respondents answered that they would either implement a new or modify an existing strategy. Ninety-three percent of respondents reported that the Sawyer method was applicable to their future teaching. The overall themes from participants were that this procedural framework allowed for personal improvement in clear communication, individualized learner-centered teaching, and improved intentionality of teaching procedures. Almost two-thirds of the faculty did not have a formal teaching method before this course, which is consistent with current data. Implementing a standardized framework for teaching procedures through faculty development workshops for multidisciplinary medical faculty educators can improve the educational quality of procedural skills.

Types of COVID-19 Disaster Work and Psychological Responses in National Guard Service Members.

The National Guard (NG) served as a critical component of the U.S. response to the coronavirus disease 2019 pandemic. Understanding the impact of types of pandemic-related disaster work on mental health responses can aid in sustaining NG service members' health and preparation for subsequent activations and future pandemics. We surveyed 1,363 NG unit (NGU) service members (88% Army; 80% enlisted; 32% 30 to 39 years old; 84% male) following activation in response to the pandemic. Surveys were administered between August and December 2020, which was approximately 2 to 3 months post-activation. Surveys assessed overall activation stress, participation in different types of disaster work, probable post-traumatic stress disorder (PTSD), anxiety and depression, and anger. A disaster work stress scale assessed different types of disaster work during activation and associated stress levels. For each individual, we calculated an overall work task stress (WTS) scaled score, with a maximum score of 100. Logistic regression analyses were conducted to examine the relationship of high-stress disaster work tasks to post-activation PTSD, anxiety and depression, and anger, adjusting for socio-demographic and service-related variables. The study was approved by the Institutional Review Board of the Uniformed Services University (USU) in Bethesda, MD. Among NGU service members, 12.7% (n = 172) described their activation as very/extremely stressful. The work tasks with the highest scaled scores were as follows: (1) Patient transportation (WTS scaled score = 100); (2) working with the dead (WTS = 82.2); and (3) working with families of coronavirus disease 2019 patients (WTS = 72.7). For each individual's work tasks, we identified the work task associated with the highest WTS score. The top one-third of WTS scores were classified as the high-stress group. Approximately 9% of participants (n = 111) had probable PTSD, 6.7% (n = 85) had clinically significant anxiety and depression, and 12.3% (n = 156) had high anger. Multivariable logistic regression analyses, adjusting for covariates, found that NGU service members exposed to the highest level of disaster WTS were more likely to report PTSD (odds ratio [OR] = 1.48 [95% confidence interval [CI] = 1.13-1.94], χ2 = 7.98), anxiety and depression (OR = 1.91 [95% CI = 1.17-3.13]; χ2 = 6.67), and anger (OR = 1.63 [95% CI = 1.13-2.37]; χ2 = 6.66) post-activation. Identifying work tasks associated with high levels of stress can help detect individuals at risk for adverse mental health responses post-exposure. Distinguishing features of high-stress work conditions can be generalized to other types of work conditions and disaster response and are important targets for planning and preventive efforts.

Military Family Perspectives on Enrollment and Engagement in the WIC Program.

One in four U.S. service members endorses food insecurity. The Supplemental Nutrition Program for Women, Infants, and Children (WIC) is an invaluable, underutilized resource that can increase access to nutritious food for families with children under 5 years of age. Our research sought to evaluate military family perceptions and engagement with the WIC program. We conducted a mixed-method study, recruiting from a convenience sample of military families who applied for financial assistance for child care. An 18-question survey and follow-up focus groups assessed participant demographics and experiences with WIC. We utilized descriptive statistics ordinal logistic regression analyses for quantitative data analysis. For qualitative data, descriptive content analysis with constant comparison and inductive and deductive coding of interviews identified emerging themes. This study was approved by the Uniformed Services University of the Health Sciences Institutional Review Board. Among the 399 survey respondents, 25% were currently enrolled in WIC and 39% had been previously enrolled. Service members and their partners learned about WIC from a variety of sources, and there was no significant association between the branch of service or rank and WIC enrollment. There were 40 total participants in 10 completed focus groups. Six themes emerged: (1) Military-specific factors create unique circumstances related to WIC engagement; (2) the WIC program facilitates access to formula supplementation and nutritious foods for military families; (3) lack of program awareness and misinformation are top barriers to WIC engagement in military families; (4) stigma impacts WIC program enrollment and engagement; (5) logistics of enrollment can impact WIC engagement among military families; and (6) the military can support WIC enrollment and engagement through standardization, education, and leadership commitment. Our findings suggest that unique circumstances related to military family life create a profound need for programs addressing food support, such as WIC. Interventions to improve WIC enrollment among military families need to be rooted in broad outreach efforts, not targeted at specific ranks, branches, or ages. Specific recommendations include increasing information dissemination, universally screening military families for WIC, decreasing logistical burdens, and involving military leadership.

Physician educators' perceptions of experiences contributing to teaching.

Physician educators are essential in training the next generation of physicians. However, physician educators' perspectives about what experiences they find beneficial to their teaching and the prevalence of these experiences remain unknown. Guided by social cognitive career theory (SCCT) and communities of practice (CoP), we explored what experiences physician educators perceive as beneficial in preparing them to teach. In 2019, the Uniformed Services University School of Medicine in the United States surveyed its physician alumni to understand their education experiences during medical school, their current career path and what has contributed to their teaching role. Content analysis was applied to extract themes across the text response. Chi-square analysis was applied to examine if perceived contributing factors vary based on physician educators' gender, specialty and academic ranks. The five most prevalent contributing factors participants (n = 781) identified are (1) experiences gained during residency and fellowship (29.8%), (2) teaching as faculty member (28.9%) and (3) class experiences and peer interaction during medical school (26%). We organised three themes that reflected major avenues of how physician educators acquire teaching skills: reflection about quality teaching, journey as learners and learning by doing. Gender and clinical specialty were differentially associated with contributing factors such as faculty development and meta-reflection. The results are in line with theories of SCCT and CoP, in which we identified self-directed learning and regulation in shaping physician educators' teaching. The findings also revealed gaps and potential contexts for more formalised teaching practices to develop physician educators.

Development and Initial Validation of the Shame Frequency Questionnaire in Medical Students.

This study presents the steps taken to develop and collect initial validity evidence for the Shame Frequency Questionnaire in Medical Students. The instrument was based on a 7-step survey design; validity evidence was collected from content, response process, internal structure, and relationship to other variables. A literature review and qualitative interviews led to the design of the initial 16-item scale. Expert review and cognitive interviewing led to minor modifications in the original structure. Initial pilot testing was conducted in August 2019 in Uniformed Services University (USU) medical students; reliability assessment and exploratory factor analysis were performed. The revised 12-item scale was tested in January 2022 in Duke University School of Medicine medical students; reliability assessment, exploratory factor analysis, and correlation analysis with depression, burnout, anxiety, emotional thriving, and emotional well-being were performed. A total of 336 of 678 USU students (50%) and 106 of 522 Duke students (20%) completed the survey. Initial exploratory factor analysis of the USU data revealed 1 factor (shame), and 4 items were dropped from the scale according to predefined rules. Subsequent exploratory factor analysis of the Duke data revealed 1 factor; no further items were removed according to predefined rules. Internal consistent reliability was 0.95, and all interitem correlations were less than 0.85 for USU and Duke samples. As predicted, mean shame scale scores were positively correlated with anxiety ( r = 0.54, P < .001), burnout ( r = 0.50, P < .001), and depression ( r = 0.47, P < .001) and negatively correlated with emotional thriving ( r = -0.46, P < .001) and emotional recovery ( r = -0.46, P < .001). The Shame Frequency Questionnaire in Medical Students is a psychometrically sound instrument with strong internal reliability and multisource validity evidence, supporting its use in studying shame in medical students.

Abstract 4820: Comparison of Black and White patients in treatment for papillary thyroid cancer in an equal access health system

Abstract Introduction: In the U.S., Black patients with papillary thyroid cancer (PTC) are less likely to receive treatment than non-Hispanic White patients. Access to care and insurance status may be related to these disparities. We aimed to compare Black and White patients in receipt of cancer care for PTC in the equal access Military Health System. Materials and Methods: We used the MilCanEpi database to identify a cohort of men and women aged 18 or older who were diagnosed with PTC between January 1, 1998 and December 31, 2014. Patients were assessed for treatment by surgery (e.g., lobectomy, thyroidectomy), adjuvant radioactive iodine (RAI), or active surveillance. Treatment appropriate for risk status (low-risk or high-risk) was compared between non-Hispanic White and Black patients using multivariable logistic regression and expressed as adjusted odds ratios (aOR) with 95% confidence intervals (CIs). Results: Among 3,511 patients with PTC, 65.0% White and 65.5% Black received surgical treatment (aOR 0.97, 95% CI 0.80-1.18 for Black vs. White). For patients with low-risk PTC, overall receipt of either surgery or active surveillance (aOR 0.86, 95% CI 0.67-1.10 for Black vs. White) was similar between races. For patients with high-risk PTC, overall receipt of surgery (aOR 1.19, 95% CI 0.71-2.01) or adjuvant RAI (aOR 1.44, 95% CI 0.60-3.44) was similar for Black compared to White patients. Conclusions: In an equal access health system, there were no overall racial differences in receipt of surgical treatment for PTC. Further, in analysis by risk status, there were no significant racial differences in receipt of active surveillance for low-risk PTC nor receipt of adjuvant RAI for high-risk PTC. This suggests the role of access to care in reducing racial disparities in treatment for PTC observed in the general U.S. population. Funding and Acknowledgement: The authors thank the Joint Pathology Center (JPC) for providing the DoD cancer registry data and the Defense Health Agency (DHA) for providing the MHS data repository (MDR) data. This project was supported by the Murtha Cancer Center Research Program (MCCRP) of the Department of Surgery, Uniformed Services University of the Health Sciences (USUHS) under the auspices of the Henry M. Jackson Foundation for the Advancement of Military Medicine (HJF, Inc.), grant numbers HHU0001-16-2-0014 and HU0001-18-2-0032 awarded to C.S. Disclaimer: The contents of this abstract are the sole responsibility of the authors and do not necessarily reflect the views, assertions, opinions, or policies of the Uniformed Services University of the Health Sciences, the Henry M. Jackson Foundation for the Advancement of Military Medicine, Inc., the Department of Defense, or the Departments of the Army, Navy, or Air Force. Mention of trade names, commercial products, or organizations does not imply endorsement by the U.S. government. Citation Format: Yvonne L. Eaglehouse, Sarah Darmon, Craig D. Shriver, Kangmin Zhu. Comparison of Black and White patients in treatment for papillary thyroid cancer in an equal access health system [abstract]. In: Proceedings of the American Association for Cancer Research Annual Meeting 2024; Part 1 (Regular Abstracts); 2024 Apr 5-10; San Diego, CA. Philadelphia (PA): AACR; Cancer Res 2024;84(6_Suppl):Abstract nr 4820.

Emergency Fresh Whole Blood Transfusion Training for Ukrainian Health Professionals in Austere Environments.

Blood is a highly valuable medical resource that necessitates strict guidelines to ensure the safety and well-being of the recipient. Since the onset of the war in Ukraine there has been an increased demand for training in emergency fresh whole blood transfusion (EFWBT) to improve damage control resuscitation capabilities. To meet this demand, we developed, implemented, and evaluated a training program aimed at enhancing Ukrainian EFWBT proficiency. Eight Ukrainian healthcare professionals (UHPs), including six physicians and two medics, completed our training, derived from the Joint Trauma System Clinical Practice Guidelines, Tactical Combat Casualty Care (TCCC) Guidelines, 75th Ranger Regiment Ranger O-Low Titer (ROLO) program, and Marine Corps Valkyrie program. Participants were assessed on their confidence in the practical application and administrative oversight requirements of an EFWBT program. A cross-comparison was conducted between a larger data set of third-year medical students from the Uniformed Services University and the UHPs to determine the statistical significance of the program. The difference in mean scores of UHPs during preand post-training was statistically significant (p<0.001). Additionally, the average rate of improvement was greater for the UHPs compared with the third-year medical students (p=0.000065). Our study revealed that the application of an EFWBT training program for UHPs can significantly increase confidence in their ability to conduct EFWBTs on the battlefield. Further larger-scale research is needed to determine the impact of this training on performance outcomes.

Evaluation ofGender Disparity inTactical Combat Casualty Care.

Women comprise nearly 19% of the U.S. military and now serve in almost all operational roles, increasing their risk of combat trauma and injuries.3 Data from the Joint Trauma Registry during Operation Enduring Freedom shows that battle-injured females had a higher case fatality rate at 36% compared to their male counterparts at 17%.1 The Tactical Combat Casualty Care curriculum is used to prepare battlefield medics to provide immediate care to wounded service members, but fails to address differences in the care of female versus male casualties. The students, who are presented with life-threatening injuries in simulated trauma scenarios, may be slower to assess, identify, and treat injuries in female patients as compared with male patients. This observational program analysis was reviewed by the Uniformed Services University Human Research Protections Program and approved for execution as an exempt protocol under the provision of 32 CFR 219.104(d)(1). The study assessed the performance of male and female Mexican military personnel during a Tactical Combat Casualty Care course, using standardized trauma scenarios. Anatomically, correct male and female manikins were used to compare response time for different gender patients presenting with the same injuries. There was a statistically significant increase in time required to complete an initial blood sweep, identify a gunshot wound to the chest, and call for medical evacuation when treating a female patient compared to a male patient. A lack of female representation in trauma training may have contributed to the higher case fatality rate of female soldiers compared to male soldiers during Operation Enduring Freedom. Female live actors and Gender Retrofit Kits can augment trauma casualty assessment and treatment training scenarios and better prepare our forces to respond to life-threatening emergencies.

Adolescents, their parents, and abortions

The opinions and assertions expressed herein are those of the author and do not reflect the official policy or position of the Uniformed Services University of the Health Sciences or the Department of Defense. Neither I nor my family members have a financial interest in any commercial product, service, or organization providing financial support for this research. References to non-Federal entities or products do not constitute or imply a Department of Defense or Uniformed Services University of the Health Sciences endorsement. This work was prepared by a civilian employee of the U.S. Government as part of the individual’s official duties and therefore is in the public domain and does not possess copyright protection

Challenges of recruitment and biomarkers collection in Caribbean Hispanics

AbstractBackgroundGenetic Studies of Alzheimer’s Disease in Caribbean Hispanics (CH) has been ongoing for over 20 years. Our primary goal was to identify genes in large well‐phenotyped, multiplex families, and sporadic cases and controls. This longitudinal collection of data represents a unique resource for the scientific community. The project is led by collaborators in the United States (US) and the Dominican Republic (DR). For the past three years, our efforts have been centered on the collection of cerebrospinal fluid (CSF), plasma, serum and Paxgene tubes for RNA to study core biomarkers. Collection of blood samples for DNA to conduct genetic analyses is also ongoing.MethodThe cohort consisted of participants aged 50 and older from the DR, including those living in the New York City area, willing and able to provide a blood and CSF samples. Interviewers in the DR were trained to collect data, blood samples and CSF. DNA samples were sent overnight to Columbia university (CU) for processing. CSF, Paxgene tubes, serum and plasma samples were processed in the DR and stored at ‐80F for batch shipping to CU. APOE genotyping was conducted in the US. Biomarkers, metabolomics, and proteomics data was generated at Columbia University. Methylation assays from Paxgene was conducted at Uniformed Services University (USUHS).ResultWe have databased a total of 1899 individuals with plasma samples, 1707 with Paxgene, 1731 with serum and 203 with CSF. Blood samples from 1079 participants have genome wide arra, whole genome sequencing and APOE genotyping. 192 CSF samples have proteomics completed, 153 CSF samples have metabolomics data and 742 have plasma biomarkers (Ab40, Ab42, T‐tau, P‐tau181, NFL and GFAP)).ConclusionSample collection for genetic studies in developing countries present important logistical challenges. Despite these challenges, sample quality is comparable to those collected in New York. Biomarkers from CSF, serum and plasma can give us a closer look into underrepresented populations such as Caribbean Hispanics. Results suggest that similar protocols can be successful in Latin America. Future work will augment the biosample collection of the cohort by collecting samples from additional subjects.

Biomarker collection from the Caribbean Hispanic families from Dominican Republic and New York.

AbstractBackgroundGenetic Studies of Alzheimer’s Disease in Caribbean Hispanics (CH) has been ongoing for over 20 years. Our primary goal was to identify genes in large well‐phenotyped, multiplex families, and sporadic cases and controls. This longitudinal collection of data represents a unique resource for the scientific community. The project is led by collaborators in the United States (US) and the Dominican Republic (DR). For the past three years, our efforts have been centered on the collection of cerebrospinal fluid (CSF), plasma, serum and Paxgene tubes for RNA to study core biomarkers. Collection of blood samples for DNA to conduct genetic analyses is also ongoing.MethodThe cohort consisted of participants aged 50 and older from the DR, including those living in the New York City area, willing and able to provide a blood and CSF samples. Interviewers in the DR were trained to collect data, blood samples and CSF. DNA samples were sent overnight to Columbia university (CU) for processing. CSF, Paxgene tubes, serum and plasma samples were processed in the DR and stored at ‐80F for batch shipping to CU. APOE genotyping was conducted in the US. Biomarkers, metabolomics, and proteomics data was generated at Columbia University. Methylation assays from Paxgene was conducted at Uniformed Services University (USUHS).ResultWe have databased a total of 1899 individuals with plasma samples, 1707 with Paxgene, 1731 with serum and 203 with CSF. Blood samples from 1079 participants have genome wide arra, whole genome sequencing and APOE genotyping. 192 CSF samples have proteomics completed, 153 CSF samples have metabolomics data and 742 have plasma biomarkers (Ab40, Ab42, T‐tau, P‐tau181, NFL and GFAP)).ConclusionSample collection for genetic studies in developing countries present important logistical challenges. Despite these challenges, sample quality is comparable to those collected in New York. Biomarkers from CSF, serum and plasma can give us a closer look into underrepresented populations such as Caribbean Hispanics. Results suggest that similar protocols can be successful in Latin America. Future work will augment the biosample collection of the cohort by collecting samples from additional subjects.

A Comparison ofUniformed Services University andHealth Professions Scholarship Program Graduates' First Deployment Readiness.

Military physicians must be prepared to lead health care teams across complex landscapes of war during future small- and large-scale combat operations. This preparation optimally begins in medical school so that early career physicians are fully ready for their first deployment. Past qualitative research has suggested that military physicians who attended civilian medical school are not as well prepared for the operational environment as physicians who attended the Uniformed Services University (USU), our nation's military medical school. However, there is a lack of larger-scale quantitative research comparing the readiness differences between the two medical school pathways. The purpose of this study, therefore, was to quantify any differences in first deployment preparation between students attending USU and civilian medical schools through the Health Professions Scholarship Program (HPSP). We compared USU and HPSP graduates' first deployment experiences by distributing a 14-item Likert survey to active duty military physicians in the U.S. Army, U.S. Navy, and U.S. Air Force who graduated within the past 10 years from medical school (USU or civilian). The USU graduates rated themselves significantly higher than the HPSP graduates on their readiness for deployment (3.83 vs. 3.24; P < .001); ability to navigate the operational environment (3.59 vs. 2.99; P < .001); confidence in communicating with their commanding officer (3.59 vs. 2.99; P = .002); navigating the combined role as physician and officer (3.33 vs. 2.84; P = .004); leading a health care team (3.94 vs. 3.43; P = .001); preparation by a medical school (3.78 vs. 2.52; P < .001); and overall readiness compared to peers (4.20 vs. 3.49; P < .001). There was no significant difference between the two pathways regarding their stress level at the beginning of deployment (2.74 vs. 2.68; P = .683); clinical preparation (3.94 vs. 3.76; P = .202); and success of first deployment (3.87 vs. 3.91; P = .792). The largest effect size of the difference between the two pathways was noted on the question "How well did medical school prepare you for your first deployment" (Cohen's d = 1.02). While both groups believed that they were prepared for their first deployment, USU graduates consistently reported being more prepared by medical school for their first deployment than HPSP graduates. To close this readiness gap, supplemental military unique curricula may help to optimize HPSP students' readiness.