Unique Backgrounds Research Articles

From Great Resignation to Great Retention: Orientation as a First Step in Engaging Faculty Well-being

Onboarding lays a foundation spanning multipart missionsand teaches faculty how to engage and excel in the departmental environment. At the enterprise level, onboarding is a process to connect and support diverse teams, with a range of symbiotic phenotypes, into thriving departmental ecosystems. At the more personal level, onboarding involves guiding individuals with unique backgrounds, experiences, and strengths into their new roles, growing both the individual and the system. This guide will share elements of an initial step in the departmental faculty onboarding process, faculty orientation.

AsianCrit lens on Chinese international student multi-dimensional transitions and experiences in the US

PurposeThe purpose of this study is to examine Chinese international students' narrative stories, experiences and racial dynamics while studying in the United States to argue that Chinese international students navigate multi-dimensional transitions and experiences in different stages. This study uses an AsianCrit lens to address the gap in existing research focusing on Chinese international students' narratives and experiences.Design/methodology/approachNarrative inquiry with a social constructivist paradigm was used to provide an in-depth exploration of Chinese international students' navigation and negotiation in multi-dimensional experiences. Three phases of semi-structured interviews and journal entries were utilized to examine participants' experiences and struggles while studying in the United States. Descriptive coding, deductive coding and restorying were used to analyze and feather narrators' voices and stories for interpretation.FindingsThe findings in this qualitative study demonstrate that Chinese international students have unique backgrounds, and their backgrounds shape their multi-dimensional transitions and experiences in the present and the future. The findings address students' nuanced experiences in academic transitions and non-academic transitions with an AsianCrit lens.Practical implicationsThe study calls for higher education institutions to promote intercultural and international training for faculty and staff to better understand and support the unique needs of international students.Originality/valueUsing Multiple and Multi-dimensional Transitions theory with an AsianCrit lens helps make sense of the intersection of international student status, geopolitical tensions, racial dynamics and international student experiences.

Investigating Teachers’ Beliefs in Inclusive Education and Their Levels of Teacher Self-Efficacy: Are Teachers Constrained in Their Capacity to Implement Inclusive Teaching Practices?

Inclusive education caters for all students and embraces their unique characteristics, backgrounds, and abilities. While many challenges persist that prevent inclusion from being fully embraced and implemented, such as varying definitions of what inclusion is at an international, national, and intra-national level, teachers’ attitudes towards inclusion and their belief in their capabilities may play an important role. This paper examined the relationship between 208 Australian primary and secondary teachers’ beliefs in inclusive education and their levels of teacher self-efficacy using t-tests. The relationship between these factors and teachers’ years of teaching experience, age, and qualifications were also investigated. The findings show that teachers who believe inclusive education is an effective way to teach all students reported higher levels of teacher self-efficacy than those who did not. Differences across teacher demographics raised a number of questions, including the role of additional qualifications and the potential influence of social attitudes towards inclusion over time on teachers’ own beliefs, each of which warrants investigation. Recommendations from the findings suggest that professional learning which supports teachers to successfully implement inclusive teaching strategies, may assist to bolster their belief in their capabilities in inclusive classrooms and in the effectiveness of inclusive education for all.

Influences of Engineering Student Backgrounds and Experiences on Conceptions of Product Design

Abstract In undergraduate engineering programs, recent emphasis has been placed on a more holistic, interdisciplinary approach to engineering education. Some programs now teach product design within the context of the market, extending the curriculum to topics outside of scientific labs and computational analysis. However, it is unknown to what extent engineering students already understand the systems and contextual factors associated with product design, and also what characteristics or experiences have led students to these ways of thinking. This study analyzes survey and concept map data collected from 154 students in a third-year engineering design course. The aim is to understand how student backgrounds and experiences influence their mental models of product design. Data were gathered from surveys on student backgrounds and experiences, along with concept maps that were generated by the students at the beginning of a product design course. The concept maps were analyzed in a quantitative manner for structural and thematic elements. The findings show that several background attributes influence student conceptions of product design. Academic major appeared to have the largest impact on a variety of variables. Additionally, prior work experience, enrollment in a master’s program, and the presence of an engineering role model at home all showed significant impacts on design conceptions. By analyzing and understanding how the unique backgrounds of students lead to differences in thought, educators can adjust their curricula to more effectively teach design concepts to students of various backgrounds and experiences.

Gender diversity and acquisitions: How female directors add value in acquisition decisions

AbstractWe investigate board gender diversity and acquisition performance. Greater gender diversity promotes value‐enhancing acquisitions. Utilizing an external shock to board composition, we determine whether and why an increase in female directors adds value. Female directors have unique characteristics relative to their male counterparts that contribute to their ability to add value during the merger and acquisition process. The positive market reaction following an acquisition is rationalized by better deal terms, monitoring around the acquisition and post‐merger performance. The extensive professional networks and unique backgrounds female directors possess are the underlying mechanisms contributing to acquisition decisions' success.

Asians Are Not Interchangeable.

To the Editor: As we celebrate Asian American and Pacific Islander Heritage Month (at the time of writing), we are compelled to address Liu and colleagues’ article by calling on medical schools across the nation to recognize the realities we face. 1 As 2 Asians in the United States, we repudiate the notion of an ethnic monolith deserving of hate by raising awareness of our distinct heritages and challenging the myth of the model minority, which assumes that all Asian American Pacific Islanders (AAPIs) are able to achieve high levels of success, because of their well-educated and hardworking nature. We are 2 AAPI physicians-in-training with unique backgrounds and experiences: Filipino-American and Hong Konger, Asian American and Asian Immigrant, native and non-native English speaker, united by this dialogue. We invite medical schools to join in this dialogue on anti-Asian hate, social invisibility, and the model minority myth by addressing the following 3 areas. First, we urge all medical schools to provide opportunities and scholarships for AAPI-related public health research. AAPI-health research is critically underfunded, comprising only 0.17% of the National Institutes of Health budget between 1992 and 2018. 1 This is exemplified by the shockingly low amount of clinical research dedicated to studying cancer in AAPIs. According to ClinicalTrials.gov, only 5 out of over 10,000 registered trials in January 2013 focused on cancer in AAPIs. 2 If research on the diseases that disproportionately affect AAPI individuals, such as liver and stomach cancers, remain underfunded, the research gap will only widen health disparities between AAPIs and the general U.S. population. Second, we ask medical schools to dismantle the barriers to success that AAPI individuals face by introducing inclusion efforts, mentorship, and career counseling. The “bamboo ceiling,” long-standing barriers in AAPI career advancement due to institutional racism, is especially salient in medicine. Compared with other ethnic groups, Asians experience a large disparity between the percentage of department chairs relative to the number of full-time faculty. 3 Third, we urge medical schools to overcome implicit bias and discrimination by integrating dialogue on the effects of anti-Asian hate within antiracism curriculum. Despite the success of AAPIs in medicine, we must not overlook the tragic history of anti-Asian sentiment in the United States, from the Chinese Exclusion Act of 1882, to the WWII Japanese internment camps, to the anti-Asian hate crimes that have risen in recent years. 1 These moments have had a profound impact on AAPIs, with race events since the COVID-19 pandemic as a particular concern for AAPI well-being and safety. As the fastest growing ethnicity group in the United States, 4 we urge all medical schools to proactively develop policies that demonstrate equity, justice, dignity, and respect toward the AAPI community.

Personalized Learning

Personalized learning is an instructional strategy that tailors instruction to learners’ unique backgrounds, interests, abilities, or needs, and commonly includes the prescription that learners have some voice and choice (i.e., agency) in such tailoring. Personalized learning is not a new strategy, though it has seen a rise in popularity in research and practice since the turn of the 21st century. Personalized learning has also seen a variety of descriptions and implementations since the turn of the 21st century. Various definitions of personalized learning have required the pedagogy to include some semblance of mastery-based learning, strong connections between learners or others included in the instruction, engaging instruction, and/or individual learning plans for each learner. There has also been a demand to describe personalized learning by including a more detailed awareness of what learning is being personalized, how it is being personalized, who controls the personalization, and what data informs the personalization.

Challenges of Managing Ethnic Workforce Diversity: A Case Study in Abuja, Nigeria.

Due to globalization and the progressive development in the country, migration in Nigeria is inevitable. Globalization and advancement in Nigeria have led to the increase in ethnic diversity in the workforce of organizations as individuals from diverse unique ethnic backgrounds, orientations, culture, etc. tend to display their different ideas and perspectives to life in the organization and it has been a challenging task for the human resource management to manage these differences. This study examines the challenges faced in managing an ethnically diverse workforce and how it influences the productivity of the organization. A qualitative research approach was employed on a sample of 49 staff of different levels in a real estate company in Abuja Nigeria, who were administered a semi-structured interview. The findings reveals that the cultural differences of the employees influence their organizational behavior in the workplace, which pose a challenge for the human resource managers to properly manage.

Infusing Mainstream STEM Education with Indigenous Culture, Language and Values

In the USA, approaches to Science, Technology, Engineering, and Maths (STEM) instruction are aligned with English-speaking, White middle-class norms. STEM courses rarely reflect consideration for the unique backgrounds of Indigenous learners. Because of this devaluing of local cultural, linguistic, and community traditions, whole communities are left behind, resulting in learners’ exclusion from advanced educational and employment tracks. Dr Sharon Nelson-Barber, Director of Culture and Language in STEM Education at WestEd, aims to change this trajectory. She and her team explore the ways in which students’ cultural backgrounds influence how they learn STEM subjects. Based on the team’s findings, they have developed innovative STEM education and assessment methods that shift relationships between Indigenous ways of learning and Western educational practices.

Experience of Indigenous Peoples' Access to Long-Term Care Services in Taiwan: A Qualitative Study among Bunun Tribes.

Indigenous communities usually have poorer access to long-term care services than non-indigenous communities because of their remote locations and unique cultural backgrounds. However, there was little exploration into the experience of indigenous people's access to the official long-term care services in Taiwan-the gap this study aimed to fill. A qualitative study design using semi-structured interviews was used to obtain data from a purposive sample. Fourteen participants who were disabled and lived among the indigenous communities of the Bunun tribes in central Taiwan were interviewed individually. The data were analyzed using Graneheim and Lundman's qualitative content analysis. The theme-"helpful but still difficult and unfit"-and three categories with eight subcategories emerged. While official long-term care services provided by the government can benefit people with disabilities in indigenous tribes, their use of such services faces a number of obstacles, which points to the need for considering culturally appropriate care. To protect the rights and interests of indigenous tribal communities, long-term care policies and practical planning must be adopted, cultural differences at play must be respected and recognized, and the necessary support must be offered to eliminate inequalities in healthcare.

Understanding the real-time interaction between middle-aged consumers and online experts based on the COM-B model

This paper presents a study of middle-aged online consumers’ specific shopping behaviour on live streaming platforms and analyses the distinct marketing strategy provided by online experts. Influenced by unique social and cultural backgrounds, middle-aged online consumers lack related shopping experience and keep counterfeiting concerns to live streaming shopping, making them prefer to interact with online experts before making final decisions. Based on the COM-B Behaviour Changing theory and the Emotional attachment theory, the research model has been established in this study, and it divides influencing factors into the Emotion unit, Opportunity unit and Capability unit. To test the relationships between influencing factors and middle-aged online consumers’ interactive motivation, the partial least-squares path modelling and variance-based structural equation modelling (PLS-SEM) have been applied on the SmartPLS. By analysing 450 samples, the study shows that the counterfeiting concern and ease of use factors positively impact online consumers’ motivation to interact with online experts, and self-efficacy plays a negative role.

Connecting With Underserved Communities Is Key to Advancing APA’s Mission

Back to table of contents Previous article Next article From the PresidentFull AccessConnecting With Underserved Communities Is Key to Advancing APA’s MissionRebecca Brendel, M.D., J.D.Rebecca BrendelSearch for more papers by this author, M.D., J.D.Published Online:20 Oct 2022https://doi.org/10.1176/appi.pn.2022.11.11.25Mental health in the United States continues to be a central part of the national conversation more than ever. Through monthly polls, APA is learning firsthand what is on Americans’ minds to advance the goal of high-quality, evidence-based care for mental and substance use disorders for every American. But, while the topic of mental health continues front and center in our individual and collective attentions, accurate evidence-based guidance is often hard to come by: All too often, readily available information about mental and substance use disorders is misleading, incomplete, or, even worse, just plain wrong. Reliable information is particularly important for members of underserved communities, including the growing number of Americans for whom English is not their native language.As psychiatrists and as citizens, we have a responsibility to the fellow Americans we serve to not just be part of the national mental health conversation but leaders and drivers of the scientifically supported and accessibility discussion around treatment for mental and substance use disorders. With our leadership, we can (and we will) actively create and promote evidence-based resources and care across the country. For example, during Hispanic Heritage Month, APA launched a groundbreaking Spanish-language campaign to raise awareness and produce evidence-based resources on mental and substance use disorders for native Spanish speakers in this country (APA Launches Website Hosting Spanish Language Resources for Patients, Psychiatrists). A member-led working group of the APA Council on Communications, chaired by Hector Cólon-Rivera, M.D., and Amalia Londoño Tobón, M.D., and composed of Hispanic and Latino APA members, most of whom are native Spanish speakers, have provided valuable guidance and content support for this initiative.This project is not simply an effort to translate APA’s existing English-language resources. While our resources contain high-quality, evidence-based information, they do not capture the unique cultural intricacies of how mental and substance use disorders are viewed and discussed in this country’s Spanish-speaking community. APA’s Healthy Minds monthly polling results remind us that the concerns of Hispanic Americans are not necessarily the same as for other Americans. Thus, all of the informational resources created by the working group, which are posted at LaSaludMental.org, were developed to be relatable, culturally relevant, and able to be read and understood by a wide segment of Spanish-speaking people in the United States, who share a common language but come from an array of unique ethnic and cultural backgrounds. As always, the expertise and lived experience of our members are huge assets as we work not only to create these resources, but also to reach out to native Spanish speakers in our country and engage with them on issues related to mental and substance use disorders.Over the past several months, members of the working group have volunteered to serve as media spokespeople for APA to the Spanish-language press and have already participated in multiple interviews with national outlets like Telemundo, Univision, and myriad local Spanish-language radio stations. Many of these interviews featured call-in segments during which our members directly engaged with the public, answered questions, and dispelled persistent myths around mental health.These real-time, informed, reliable, and accessible interactions are crucial to confronting and eradicating stigma, misinformation, and general confusion about mental health for Spanish speakers. The more our members can participate in these conversations with patients, families, and the public, the more progress we will make in raising awareness of the importance of mental health and seeking help when needed. We will also be more successful in reaching young people of all cultures and backgrounds whom we need to become the psychiatrists of tomorrow and gain precious ground in the fight against stigma and misinformation as barriers to mental health care.The Spanish Language Communications Initiative is a massive undertaking and a major starting point for APA’s outreach to minority and underserved communities. While this initiative is our most intensive outreach effort right now, much of APA’s day-to-day work is focused on giving psychiatrists the tools they need to establish ourselves and our profession as trustworthy so that we may engage with patients from a wide variety of ethnic, religious, racial, and cultural backgrounds in advancing the mental health of every American. These public outreach efforts, especially to our neighbors historically excluded from the benefits of mental health care, are mission critical for the future of our profession and our society. To find out more, please visit www.LaSaludMental.org, and, as always, I look forward to hearing about your ideas and innovative work for the future of psychiatry. Don’t forget to follow me on Twitter @Pres_APA. ■ ISSUES NewArchived

Effects of Traditional Ethnic Minority Food Culture on Genetic Diversity in Rice Landraces in Guizhou Province, China

Ethnic minorities living in Guizhou Province, China, have produced numerous rice landraces that are rich in genetic variations. Studying the genetic diversity and population structure of rice landraces in Guizhou has therefore become a topic of great research interest. However, the influence of ethnic minorities and their traditional food cultures on rice landraces remains unclear. We analyzed the genetic diversity of 598 rice landraces using simple sequence repeat (SSR) markers. Furthermore, we analyzed the nucleotide variations between two similar populations collected during two different time periods using a single-nucleotide polymorphism (SNP) haplotype analysis of six unlinked nuclear loci. The three major results were as follows: (1) The genetic diversity index of rice landraces in six ecologically distinct rice farming zones of Guizhou Province was high (He = 0.7721), and Southwest Guizhou, which has a large population of ethnic minorities, is the center of genetic diversity of rice landraces in the province; this region had the highest He at 0.7823 and the highest polymorphic information content (PIC) at 0.7562. (2) A neighbor-joining (NJ) phylogenetic tree and a model of the population structure showed that the rice landraces from the southwest, south, and southeast of Guizhou had unique genetic structures and genetic backgrounds, which are closely related to the traditional diet cultures of the local ethnic minorities. (3) A nucleotide variation analysis of similar rice landraces collected in 1980 and 2015 revealed that, after 35 years of domestication by ethnic minorities, the original dominant haplotypes were well-preserved; the frequency of the most favorable haplotypes gradually increased to adapt to the traditional food culture. This study is expected to promote the protection and sustainable utilization of rice landraces from this unique region and to provide valuable germplasm materials and information for future rice breeding and basic research efforts.

Sexual orientation and gender identity (SOGI) data in dermatologic studies and opportunities for inclusion.

Dermatologists serve a vast array of patients with unique backgrounds. The National Institutes of Health (NIH) designated members of sexual and gender minorities as underrepresented in scholarly literature. Our study examines the past 10 years of studies published in highly-cited dermatologic journals, surveying each study for common data collection of sexual orientation and gender identity (SOGI) in dermatological studies. We found representation of sexual and gender minorities to be increasing in dermatological studies but recommend that SOGI data be collected regularly just as any other common variable in dermatological patient studies.

Impact of War and Resettlement on Vietnamese Families Facing Dementia: A Qualitative Study

ABSTRACT Objectives Most Vietnamese immigrants in the U.S. today arrived as political refugees due to the Vietnam War in the late 20th century. Refugees are disproportionally affected by health and mental health disparities as a result of experiencing distress and potentially traumatic experiences before, during, and after their migration processes. This study involved Vietnamese families facing dementia and used a qualitative approach to investigate participants’ experiences before, during, and right after their resettlement in the U.S. Methods In-person interviews were conducted with 11 Vietnamese adults who cared for their family member with dementia. A descriptive analysis approach was used. Results Five major themes emerged from the interviews:1) immigrating separately from family members, 2) difficult and unsafe journeys, 3) experiences of loss, 4) lack of support systems in the U.S., and 5) feelings of unhappiness, sadness, or signs of depression. Conclusions This study provides a close examination of Vietnamese refugees’ unique backgrounds and how individuals with dementia and their caregivers from this population may be disproportionally impacted by stress. Clinical Implications To reduce health disparities, we recommend that providers and policymakers allocate more resources for culturally appropriate routine assessment, treatment, and referrals of those with dementia and their caregivers.

A Method for Identifying Urban Functional Zones Based on Landscape Types and Human Activities

The effects of land use and socioeconomic changes on urban landscape patterns and functional zones have been increasingly investigated around the world; however, our knowledge on these effects is still inadequate for sustainably managing urban ecosystems. The urban functional zone (UFZ) refers to a kind of regional space that provides specific functions for human activities and reflects the land use type in a city. They are important for urban planning and exploring urban texture dynamics. UFZs improve understanding of sustainable development for urban ecosystems with extreme environments and unique social backgrounds. However, the identification methods for UFZs are incomplete because of a lack of socioeconomic attributes, as well as their hierarchical relations. Here, we present a hierarchical weighted clustering model to identify UFZs based on the entropy weight method. The data included points of interest (POIs), land use type data, road network data, socioeconomic data, and population density. We found that the adjusted cosine metric and the average criterion were the optimal distance metric and linkage strategy, respectively, to cluster urban zone data. The performance with weighted data was better than that with raw data, and the level of the POI classification scheme and landscape pattern affected the accuracy of identification UFZs. The research indicated that the hierarchical weighted clustering model was a useful method to classify UFZs in order to improve urban planning and environmental management schemes.

Clerkship for Personal Growth: Teaching Psychiatry to Medical Students

Back to table of contents Previous article Next article Education & TrainingFull AccessClerkship for Personal Growth: Teaching Psychiatry to Medical StudentsFernando Espi Forcen, M.D., Ph.D.Fernando Espi ForcenSearch for more papers by this author, M.D., Ph.D.Published Online:28 Jan 2022https://doi.org/10.1176/appi.pn.2022.2.34AbstractPsychiatry teachers should use multiple communication skills to stimulate curiosity, creativity, and compassion to maximize medical students’ experience in their psychiatry rotation.A psychiatry clerkship offers the distinctive opportunity to study not just the human brain, but the human mind. Critically, it is not just the minds of patients but also those of students and teachers who are impacted; done right, a psychiatry clerkship leaves no one untouched.Before students are exposed to the field of psychiatry, all kinds of ideas may cross their minds. People have different thoughts and feelings about what mental illness is and how it should be handled. At the same time, psychiatry, our beloved field, has been affected by its troubled past and attempts to devise treatments that seem barbaric today. Nonetheless, a day or two into medical students’ psychiatry clerkship rotation, prior conceptions about psychiatry rapidly fade away. They are pleased to discover that psychiatry can be joyful, approachable, and helpful not only in the treatment of individuals with mental illness but also in understanding the psychology of our daily lives.Though most students are excited for their psychiatry clerkship, they start with some trepidation. After being assigned to a new team and given a brief orientation, they have to figure out the culture of their new rotation quickly. Sometimes they get to work with a team for a few weeks, other times just one afternoon. While there are overall goals, every supervisor they encounter may have particular expectations for them. Whatever happens is no longer completely up to them. Treatment may not go well even if they are trying hard. Being intelligent or a hard worker is no longer the key. Now they must also demonstrate interpersonal skills and the ability to cope with the uncertainty of not having absolute control of the patient’s outcome. These are new and difficult lessons to master, but ones that will help students in their future careers.Like most human beings, medical students are auditory, visual, and kinesthetic learners. In school, we are well taught how to master auditory communication, but we at times neglect the latter two communication skills. We do a good job of reporting and sharing clinical data, but sometimes we dismiss other ways to bring a message home. It is important to explain and review complex concepts about psychiatry and to stimulate students’ curiosity about the field, which will help them academically. Perhaps even more important, however, is to stimulate students’ creativity and compassion—these are not characteristics one can learn from a book.As teachers, we will have a greater chance of communicating effectively with our medical students if we consider all three facets of learning. For example, if I say, “This is a patient with a history of schizophrenia presenting with delusions,” I may not be as effective a communicator as if I say instead something visual like, “This woman was found under a bench at the park freezing in the cold and talking loudly about the end of the world.” With the second description, medical students can better visualize that person who has schizophrenia in a way that they will remember. Kinesthetically, I may add an emotional component and say, “This is a woman found under the bench at the park, alone and crying out loud about the end of the world after losing the custody of her daughter.”In teaching, positive reinforcement is effective, but more powerful, and more difficult, is social modeling. Medical students are still evolving into independent physicians, and clerkships represent perhaps the most vulnerable period of their careers. As supervisors, we need to enable students to navigate their anxieties about their performance on their own. At the same time, we can provide support and help them view their obstacles with perspective. Struggling can become a great teacher, and the experience of overcoming obstacles can foster growth. Hence, adversity in medical school can turn into one of the most meaningful experiences for their future careers.Therefore, as models, we teachers must first work on ourselves. Before we teach, we must be aware of our own affects. We are responsible for creating a healthy environment that supports learning. For me, teaching medical students has been an opportunity to create a mutually enriching experience. To learn about their unique backgrounds, interests, and personal circumstances has helped me grow as a teacher and a human being. Through helping other people, we help ourselves. ■The author acknowledges Deirdre Gorman and Nick Zagorski for help in developing this manuscript.Fernando Espi Forcen, M.D., Ph.D., is faculty for the students’ core clinical experience at Massachusetts General Hospital. ISSUES NewArchived

Mothers, precious allies in the support of adolescents

The Maison des adolescents of theCochin Hospital in Paris is a multidisciplinary structure with a transcultural sensitivity. It welcomes young people, but also their families, and take into account their unique backgrounds. From thereception of the adolescent by the consultation nurse to the implementation of specific care in atranscultural group, the care pathway sometimes requires the mother-adolescent dyad to be carried along in order to achieve an appeasement of the sufferings of each.

FEASIBILITY, DELIVERY, AND IMPLEMENTATION OF A REMOTE CRITICAL CARE TRAINING PROGRAM IN CHINA: THE CERTAIN APPROACH

TOPIC: Education, Research, and Quality Improvement TYPE: Original Investigations PURPOSE: To describe the development, implementation, and learner engagement in a longitudinal international remote critical care continuing medical education program in China. METHODS: Based on the Mayo Clinic Checklist for Early Recognition and Treatment of Acute and Illness and iNjury (CERTAIN) program, we designed and delivered a longitudinal 40-week remote coaching program for a community-based teaching hospital in Shandong Province, China. Based on a mixed-methods needs assessment that included learner feedback using an exploratory sequential design and ICU process and outcomes data, we developed a curriculum that included asynchronous, online learning modules with multiple language captions and weekly remote education sessions using a blend of didactic presentations on common critical care syndromes, virtual simulation, journal club, and case-based discussions. Faculty included a diverse group of critical care experts and bilingual facilitators. The program also included clinical research and quality improvement workshops to facilitate implementation of key concepts identified during these activities. Participants completed a survey using a 5 point anchored Likert scale after each educational activity to provide feedback and guide course improvement. RESULTS: Twenty-two Chinese clinicians (18 physicians, 4 nurses) enrolled in this CERTAIN longitudinal program. Learners completed a total of 163 hours (mean 7.4 hr/learner) asynchronous online learning, and to date have completed 23 weekly education sessions (total 28 hours, including an extended virtual simulation experience). Survey response rate was 56%. Learners reported a high rate of overall satisfaction with the course (112, 61% Excellent; 55 (30%) Very Good) and specific topic discussions (110,60% Excellent; 57, 31% Very Good), with steady improvement over time. Perceived practice relevance was also high (110, 59% Excellent; 55,30% Very Good), and this effort has informed ongoing local performance improvement initiatives. CONCLUSIONS: Remote delivery of longitudinal critical care continuing education program in China using asynchronous learning, case-based discussion, and virtual simulation is feasible, associated with a high rate of learner satisfaction, and increases engagement in quality improvement initiatives. This innovative global education initiative offers an important potential solution to strengthen critical care services in remote, resource-limited settings at low cost, especially during the ongoing COVID-19 pandemic. CLINICAL IMPLICATIONS: The World Health Organization has identified remote education programs as a priority to strengthen international critical care services and better meet growing global clinical demand. The best method to effectively deliver continuing medical education to international healthcare providers with unique cultural, organizational, and practice backgrounds is not well defined. DISCLOSURES: no disclosure on file for Wenjuan Cui; No relevant relationships by Yue Dong, source=Web Response Patent/IP rights for a licensed product relationship with Ambient Clinical Analytics Please note: From 2016 Added 05/23/2021 by Ognjen Gajic, source=Web Response, value=Royalty No relevant relationships by Heyi Li, source=Web Response No relevant relationships by Alexander Niven, source=Web Response no disclosure on file for Lujun Qiao; No relevant relationships by Yuqiang Sun, source=Web Response no disclosure on file for Qingzhong Yuan

Perceptions of Behavioral Awareness, Intention, and Readiness for Advance Care Planning: A Mixed-Method Study among Older Indigenous Patients with Late-Stage Cancers in Remote Areas of Eastern Taiwan.

The first Patient Right to Autonomy Act enacted in Asia in 2019 has enabled every Taiwanese citizen to plan for his/her end-of-life (EOL) in case of incompetency. Advance care planning (ACP) has been highly promoted for individuals with terminal, life-threatening illnesses, particularly in the mainstream society, and efforts have been made by the Taiwanese government to train health care providers in order to optimize patients’ quality of dying. However, such advanced decisions and discussions regarding life-sustaining treatment and EOL care remain scarce among older ethnically minority patients. A multiple-case study employing a mixed-method (n = 9) was undertaken to explore indigenous patients’ ACP perceptions. Both quantitative and qualitative information was obtained from indigenous patients, a minority group whose socio-economic and educational status are different from the general Taiwanese population. An initiative was made to describe ACP behavioral awareness, intention, and readiness of older terminal patients from four tribes with seven late-stage cancers in remote, mountainous areas of eastern Taiwan. Our findings showed that according to the Transtheoretical Model, terminal indigenous patients’ ACP readiness was at a precontemplation stage. Their lack of fundamental ACP awareness, insufficient healthcare resources, life-sustaining value in a Christian faith context, and the prevalent health disparity in the remote communities have negatively affected indigenous patients’ intention to participate in ACP. We provide suggestions to further promote ACP in this group and suggest that health information should be tailored at various readiness stages in order to overcome barriers and decrease ACP literacy discrepancies. This study calls attention to an understudied area of ACP behaviors, an overlooked need in EOL care for older cancer patients of unique cultural backgrounds, and the imperativeness to ensure cultural minority group’s EOL care is consistent with patients’ preferences.