Virginia Commonwealth University School Research Articles

Milk and Cookies: A model for low‐intensity intervention for children with an incarcerated parent

Recently, my niece, a graduate student in clinical psychology, sent me an article she published with her undergraduate faculty mentor. The article is cited below (Walters & Dallaire, 2024) and summarizes the outcomes of a specialized group intervention for children with an incarcerated parent called Milk and Cookies (MAC). Her mentor provides evaluative support for MAC via her research lab at William and Mary. MAC is offered through a nonprofit organization in Virginia called Assisting Families of Inmates, Inc. (AFOI). AFOI works with families with an incarcerated member to facilitate reunification both prior to and after release from incarceration. The group leaders for MAC are recruited from Virginia Commonwealth University's School of Social Work.

Effect of clear aligner attachment design on extrusion of maxillary lateral incisors: A multicenter, single-blind randomized clinical trial

Extrusion of maxillary lateral incisors during aligner treatment is a difficult movement to achieve accurately. Despite recommendations regarding attachment design, few studies and no prospective trials compare predictability among attachments. This study aimed to compare the efficacy between optimized and horizontal attachment designs for achieving maxillary lateral incisor extrusion during clear aligner treatment. The study included maxillary lateral incisors in 3 orthodontic practices requiring at least 0.3 mm of extrusion during the first series of 20-25 aligners in patients aged ≥16 years who were scheduled to begin clear aligner treatment (Invisalign; Align Technology, San Jose, Calif). Teeth were randomly assigned to receive optimized (O), rectangular horizontal nonbeveled (H), rectangular horizontal incisally-beveled (HIB), or rectangular horizontal gingivally-beveled (HGB) attachments. After the first series, a blinded evaluator measured extrusion using superimpositions with initial and predicted models. Linear models determined the difference in the predicted extrusion percentage achieved on the basis of attachment design. Other covariates were patient age, sex, number of trays, and self-reported compliance. Forty patients (74teeth) were enrolled, and 38 patients (71 teeth) completed the study. Intraexaminer and interexaminer reliability for extrusion measurements was high (intraclass correlation coefficient, 0.985 and 0.991, respectively). The achieved extrusion was significantly less than predicted (mean, 73%; P<0.0001). The average achieved extrusion was 62%, 79%, 78%, and 78% for O, H, HIB, and HGB attachments, respectively, with H significantly more effective than O (P= 0.0403). Horizontal attachments (H, HIB, and HGB combined) were significantly more effective than O attachments (P= 0.0060), with an average difference in achieved extrusion of 14% of the predicted amount (95% confidence interval, 4-23; estimated 76% vs 62%). Horizontal attachments were an estimated 22% more effective than O attachments for extruding maxillary lateral incisors. Horizontal attachments are more effective than O attachments for predicted maxillary lateral incisor extrusion between 0.3 and 2.5 mm. The 3 horizontal attachment designs evaluated performed similarly for achieving predicted extrusion. This randomized clinical trial was registered and reported at clinicaltrials.gov (NCT04968353). The protocol was not published before trial commencement. This study was funded in part by the Alexander Fellowship of the Virginia Commonwealth University School of Dentistry, the Southern Association of Orthodontists, and the Virginia Orthodontic Education and Research Foundation. No funding source influenced the study design, the collection, analysis or interpretation of data, writing of the report, or the decision to submit the article for publication.

Reducing Gadolinium Exposure in Patients Undergoing Monitoring for Meningiomas.

Background Due to the non-malignant and slow-growing nature of many meningiomas, surveillance with serial magnetic resonance imaging (MRI) serves as an acceptable management plan. However, repeated imaging with gold-standard contrast-based studies may lead to contrast-associated adverse effects. Non-gadolinium T2 sequences may serve as a suitable alternative without the risk of adverse effects of contrast. Thus, this study sought to investigate the agreement between post-contrast T1 and non-gadolinium T2 MRI sequences in the measurement of meningioma growth. Methodology The Virginia Commonwealth University School of Medicine (VCU SOM) brain tumor database was used to create a cohort of meningioma patients and determine the number of patients who had T1 post-contrast imaging accompanied by readily measurable imaging from either T2 fast spin echo (FSE) or T2 fluid-attenuated inversion recovery (FLAIR) sequences. Measurements of the largest axial and perpendicular diameters of each tumor were conducted by two independent observers using T1 post-contrast, T2 FSE, and T2 FLAIR imaging series.Lin's concordance correlation coefficient (CCC) was calculated to assess inter-rater reliability between observers and agreement between measurements of tumor diameter among the different imaging sequences. Results In total, 33 patients (average age = 72.1 ± 12.9 years, 90% female) with meningiomas were extracted from our database, with 22 (66.7%) undergoing T1 post-contrast imaging accompanied with readily measurable imaging from T2 FSE and/or T2 FLAIR sequences. The inter-rater reliability between the measurements of T1 axial and perpendicular diameters was 0.96 (95% confidence interval (CI) = 0.92-0.98) and 0.92 (95% CI = 0.83-0.97), respectively. The inter-rater reliability between the measurements of T2 axial perpendicular diameters was 0.93 (95% = CI 0.92-0.97) and 0.89 (95% CI = 0.74-0.95), respectively. The agreements between the measurement of T1 and T2 FSE axial diameter by each observer were 0.97 (95% CI = 0.93-0.98) and 0.92 (95% CI = 0.81-0.97). The agreements between the measurements of T1 and T2 FSE perpendicular diameter measurements by each observer were 0.98 (95% CI = 0.95-0.99) and 0.88 (95% CI = 0.73-0.95). Conclusions Two-thirds of our patients had meningiomas that were readily measurable on either T2 FSE or T2 FLAIR sequences. Additionally, there was excellent inter-rater reliability between the observers in our study as well as an agreement between individual measurements of T1 post-contrast and T2 FSE tumor diameters. These findings suggest that T2 FSE may serve as a safe and similarly effective surveillance method for the long-term management of meningioma patients.

Understanding Academic Self-Concept and Performance in Medical Education.

Medical students' academic self-concept (ASC) is an important factor in better understanding noncognitive mediators of performance in medical school. However, research is limited on ASC in medical students across multiple phases of undergraduate medical education curriculum. This pilot study explored the relationship between ASC and academic performance across different phases of a U.S. medical school curriculum, specifically at the end of the second (preclinical) and third (clinical) years. Medical students across 2 cohorts at Virginia Commonwealth University School of Medicine, Richmond, Virginia, were surveyed using an ASC confidence subscale in 2019. Multiple linear regression analysis was conducted using medical student ASC scores in preclinical (n = 190) and clinical (n = 149) phases and performance data. Clinical performance was calculated through a weighted mean of clerkship grades based on the number of weeks for each clerkship. Preclinical performance was related to ASC, gender, and performance after year 1. ASC scores varied significantly by gender in the preclinical cohort ( P < .01), with men reporting higher ASC than women (mean [SD], 2.94 [0.41] vs 2.78 [0.38]). Significant gender differences in performance were found at the end of year 3 ( P < .01), with women performing more favorably compared with men (mean [SD], 94.1 [59.04] vs 124.24 [64.54]). The relationship between ASC and performance at the end of year 2 suggested students with higher ASC perform better during their preclinical phase. This pilot study supports future scholarship in 2 areas: (1) identification and assessment of additional factors that influence the relationship between ASC and academic performance across the entire undergraduate medical education curriculum and (2) development and implementation of evidence-based interventions to support student ASC and performance and enhance the learning environment. Analyzing longitudinal trends across multiple cohorts will drive evidence-based interventions at learner and programmatic levels.

Shortened PANSS Developed for Children and Adolescents

Back to table of contents Previous article Next article Clinical & ResearchFull AccessShortened PANSS Developed for Children and AdolescentsNick ZagorskiNick ZagorskiSearch for more papers by this authorPublished Online:24 Feb 2023https://doi.org/10.1176/appi.pn.2023.03.3.15AbstractThe 10-item pediatric Positive and Negative Syndrome Scale (PANSS) is almost as accurate as the 30-item PANSS and can be administered in a fraction of the time.A 10-item version of the Positive and Negative Syndrome Scale (PANSS) can reliably assess psychosis symptoms in children and teens, according to a report in the Journal of the American Academy of Child and Adolescent Psychiatry.With the traditional PANSS, which was developed for adults, an interviewer evaluates the patient for 30 symptoms, rating each symptom on a scale of 1 (absent) to 7 (extreme). These symptoms fall under five domains:Positive symptoms (for example, hallucinations and delusions)Negative symptoms (for example, social withdrawal) Excited symptoms (for example, hostility) Cognitive symptoms (for example, poor attention) Affective symptoms (for example, depression and anxiety)An adult evaluation using the PANSS can take about an hour to administer, which places a burden on both the patient and interviewer, noted Robert L. Findling, M.D., M.B.A., professor and chair of psychiatry at Virginia Commonwealth University School of Medicine. When using the scale to evaluate children and adolescents, the interviewer has discussions with both the youth and their parents, which can add more time.Robert L. Findling, M.D., M.B.A., notes that the inclusion of hallucinations—considered one of the hallmark symptoms of schizophrenia—in the pediatric PANSS did not appear to improve the accuracy of the evaluation.Other researchers have tested shorter versions of PANSS that attempt to maintain the precision of the 30-item scale while reducing the time it takes to administer the evaluation. These include a 19-item scale and two brief 6-item versions. However, as with the 30-item PANSS, these shortened versions of the scale were developed using adult patient data, Findling explained. “It’s important that we develop and test a pediatric-specific scale, because while the diagnostic criteria for psychotic disorders are the same for youth and adults, the symptom presentations do differ,” he said.To create a pediatric PANSS, Findling and colleagues used baseline data from an eight-week clinical trial that compared the safety and efficacy of the antipsychotics olanzapine and risperidone with the older antipsychotic molindone in youth. For that study, which was published in The American Journal of Psychiatry, 116 participants aged 8 to 19 years with early onset schizophrenia or schizoaffective disorder were assessed with the 30-item PANSS along with other behavioral assessments every week for eight weeks.Findling and colleagues evaluated different combinations of symptoms using this patient data set to find a combination that maximized both fidelity to the full-length PANSS (for both mild or severe symptom profiles) and time savings. The researchers sought to include symptoms from the five domains of the 30-item PANSS when creating the pediatric PANSS but did not pick any specific items ahead of time. “We wanted to let the data speak for itself,” he said.The pediatric PANSS included 10 symptoms evenly spread across the five domains. They were as follows:Delusions and unusual thoughtsEmotional withdrawal and apathyHostility and poor impulse control Inattention and disorganized thinking Anxiety and feelings of guiltThe 10-item PANSS took significantly less time to administer and matched the 30-item PANSS in the AJP data set 88% of the time. It was also accurate for both mild and severe symptom scores and could reliably identify symptom changes over time.“Overall, I think this shortened version performs pretty well, as it preserves the PANSS’s broad coverage of symptoms in a format that is briefer and easier to interpret,” Findling said. “We need to validate this scale in more diverse populations.”This study was supported by funding from Signant Health. The trial that provided the data was supported by the National Institute of Mental Health. ■Resources“An Optimized Version of the Positive and Negative Symptoms Scale (PANSS) for Pediatric Trials” ISSUES NewArchived

Developing Marsha and Marian’s Neighbors: A Shared Housing Intervention to Address Homelessness among LGBTQ+ and Pregnant/Parenting Youth

Background: The aim of this paper is to describe the development of a shared housing model intervention that was designed to serve youth experiencing homelessness who are LGBTQ+ and/or pregnant/parenting. The intervention is built around two guiding philosophies: housing first and restorative justice. Methods: We engaged in a year-long planning process with an advisory group from 1 July 2021 through 30 June 2022. The advisory group is a partnership between Virginia Commonwealth University School of Social Work, seven young people with lived experience expertise, and members from four partner organizations, including local organizations serving LGBTQ+ youth. Results: Marsha and Marian’s Neighbors is designed to provide safe, comfortable housing for 12 months for 20 young people and their children if they have any. Participants will live in apartments where rent and utilities are paid for by the program for all participants. The program also provides money for arrears that may prevent the participants from being able to secure a lease, mental health appointments, legal consultations, and doula services provided by partners recruited by the planning team. Services are provided by staff and partners that are LGBTQ+ affirming and pregnant and parenting affirming. Conclusion: One of the most important lessons that we learned is the power of developing shared values in a novel intervention for LGBTQ+ youth. One focused intervention that supports both pregnant and parenting youth who identify as LGBTQ+ remains necessary. Paradoxically, LGBTQ+ people, particularly bisexual, lesbian, and queer cisgender women, are at an equal or greater risk of unplanned pregnancy. Both groups are vulnerable to housing instability independently, and those who live at the intersection of being LGBTQ+ and pregnant/parenting face an elevated risk for housing instability.

In Response to the Letter to the Editor Regarding The History of Otology and What We Can Learn from It: Putting Historical Research in Context.

In Reply We thank Dr. Ruben for his interesting point regarding our recent editorial The History of Otology and What We Can Learn from It: Putting Historical Research in Context. In his epochal text De aure humana tractatus, Valsalva1 provided detailed anatomical descriptions of the external, middle, and inner ear. Valsalva may have first suggested an acoustic property of the semicircular canals. The idea that semicircular canals function as auditory organs seems to have been pervasive when Flourens was active in research. For example, Josef Hyrtl, an Austrian anatomist and contemporary of Flourens, compared the inner ears of 24 different animals and proposed that the canals were responsible for directional hearing. It was only after the works of physician Josef Breuer, physicist Ernst Mach, chemist Alexander Crum Brown, and physiologist Ernst Ewald in the late 19th century that the function of the canals became more apparent.2 We deeply appreciate Dr. Ruben's laborious efforts in translating De aure humana tractatus.3 The challenging work of translating historical texts and uploading them to online journal databases is crucial to maintaining the scientific record. Sincerely, Pavan Krishnan, B.A. Nicholas Andresen, M.D. Bryan Ward, M.D. Pavan S. Krishnan, B.A. Virginia Commonwealth University School of Medicine Richmond, VirginiaNicholas S. Andresen, M.D. Department of Otolaryngology–Head & Neck Surgery, Johns Hopkins School of Medicine Baltimore, MarylandBryan K. Ward, M.D. Division of Otology, Neurotology, and Skull Base Surgery, Department of Otolaryngology–Head & Neck Surgery, Johns Hopkins School of Medicine Baltimore, Maryland [email protected]

Residents' assessment of mentoring received on lecture performance in a teaching and learning curriculum program

IntroductionThis study evaluated residents' assessment of the mentorship received and how it impacted lecture performance as part of a teaching and learning curriculum (TLC) program. MethodsAn anonymous survey was emailed to residents completing the Virginia Commonwealth University (VCU) School of Pharmacy's TLC during 2018–2019 and 2019–2020. The survey collected information about: the type of mentorship received, residents' self-perceived lecture performance, and residents' desire to be involved in academia post-residency. Data were summarized using descriptive statistics. Fisher's exact tests investigated the association between residents' self-perceived lecture enhancement due to mentorship and: mentors' involvement, residents' confidence in understanding the lecture topic, mentors' affiliation with VCU, and semester when the lecture occurred. Responses to open-ended questions were analyzed using thematic analysis. ResultsForty-two of 86 residents (48.8%) completed the survey. Residents who were part of the TLC but did not deliver a lecture (n = 7) or taught practitioners instead of students (n = 2) were excluded, resulting in 33 participants. The majority of residents (87.9%) agreed or strongly agreed that mentorship enhanced their lecture. Mentors' level of involvement was significantly associated with residents' perception that the mentorship they received enhanced their lecture (P < .008). Residents' confidence in understanding the lecture topic, mentor affiliation, and semester when the lecture occurred were not associated with residents' self-perceived lecture enhancement due to mentorship. ConclusionsActive mentorship was associated with better self-perceived lecture performance. The best criteria for lecture mentorship should be established in the future to help prepare residents to give lectures.

The Power of the Pen: Writing to Amplify Our Communities' Voices.

1Fourth-year medical student, Virginia Commonwealth University School of Medicine, Richmond, Virginia; email: [email protected]; Twitter: @mattvalexander; ORCID: https://orcid.org/0000-0002-8157-3745. 2Third-year medical student, University of Michigan Medical School, Ann Arbor, Michigan; ORCID: https://orcid.org/0000-0002-6677-221X. 3Third-year medical student, University of Michigan Medical School, Ann Arbor, Michigan. Funding/Support: None reported. Other disclosures: None reported. Ethical approval: Reported as not applicable. First published online.

An intensive summer pipeline program for pre-pharmacy students to increase underrepresented minority matriculation to pharmacy school

Background and purposeTo describe the Summer Academic Enrichment Program (SAEP) for underrepresented minority (URM) matriculants at Virginia Commonwealth University (VCU) School of Pharmacy. Educational activity and settingThe SAEP is a six-week summer pipeline program at VCU for undergraduate and post-baccalaureate students interested in applying to medical, dental, physical therapy, or pharmacy school, divided into school tracks. Demographic and matriculation information about the pharmacy track program participants was obtained from the program and school administration from inception in 2012 through 2019. A retrospective analysis of the impact of SAEP on URM matriculation at VCU School of Pharmacy was conducted. FindingsOf the 80 pharmacy track participants, 56.3% (n = 45) have enrolled at VCU School of Pharmacy. Among those 45 that matriculated, 33.3% (n = 15) identified as one or more of the following URM populations: Black or African American 28.9% (n = 13), Hispanic or Latinx 4.4% (n = 2), and American Indian 2.2% (n = 1). In comparison, the same URM classifications for students enrolled at VCU School of Pharmacy over the last nine years ranged from 5% to 11% Black or African American, 0% to 5% Hispanic or Latinx, and 0% to 2% American Indian with a total URM representation range of 7% to 25% during this timeframe. SummarySAEP is a program utilized to increase matriculation of students from diverse backgrounds, including URM populations. This type of pipeline program is described as one way to improve URM representation.

Editorial introductions.

Editorial introductions.

The United States 2020 Census data: implications for precision medicine and theresearch landscape.

The United States 2020 Census data: implications for precision medicine and theresearch landscape.

Perspectives of Dental Students in Oral Surgery Education and Training

Graduating dental students are expected to be competent in performing minor oral surgical procedures, but this depends on their education and training while in dental school. Students’ self-perceptions in performing surgical procedures offer valuable insights and highlight shortcomings in the current oral and maxillofacial surgery (OMS) education and training. The surgical skills of dental students have been found deficient in certain aspects in previous surveys conducted in Europe (Macluskey, et al, 2012; Cabbar, et al, 2019), but none have been conducted/published in the United States. The aim of this study is to evaluate dental students’ self-perception of their competency in surgical skills to perform oral surgical procedures and practice "independently" at a dental school in the United States.A cross-sectional survey of dental students in class of 2021 (D4) and 2022 (D3) was conducted at Virginia Commonwealth University (VCU) School of Dentistry February-March 2021. The Association of British Academic Oral Maxillofacial Surgeons (ABAOMS) questionnaire was utilized and adapted, with permission, in accordance with the OMS curriculum in U.S. dental schools. The questionnaire (Figure 1) involves 17 items covering 5 domains (information, experience, skills, knowledge, and interest, in addition to feedback section for comments). The responses were scaled on a 5-point Likert-type scale. The anonymous data were collected and entered into the REDCap database, and the responses were summarized using descriptive statistics and compared using Fisher's Exact test. A P-value of < .05 was considered statistically significant. All narrative feedbacks were tabulated and analyzed qualitatively. Ethical approval was obtained from the Institutional Review Board (IRB # HM20020893).Sixty-four students (46 D3, 18 D4) participated (32 M, 32 F). Most D3 students performed fewer than 25 extractions (91%), while most D4 performed more than 25 extractions (89%). Analysis of the responses per question is detailed in Figure 2. Comparative analysis between the classes showed that the D4 were significantly more confident than D3 in performing surgical extractions while the D3 were significantly more confident in understanding head and neck anatomy. Comparative analysis between the genders showed that the females were significantly more confident than males in various aspects of OMS practice. Overall, the majority of D3 and D4 students felt more confident performing simple dental extractions than surgical extractions. Most students felt the OMS specialty is an enjoyable and rewarding discipline and consider practicing OMS procedures after graduation despite feeling unconfident in certain aspects. Qualitative analysis revealed that the main recurrent themes were the limited time allowed and devoted to practice dental extractions and the need for more hands-on supervised training.The students’ responses highlight the importance of teaching and supervised training by oral surgery faculty and the need to allocate more time to practice surgical procedures to enhance students’ self-confidence. The questionnaire is a useful survey tool to evaluate, and subsequently improve, the OMS curriculum, teaching, and training among the U.S. dental schools. The plan is to conduct a national survey via future collaboration with the ADA and AAOMS.

Export Linking Public Institutions of Higher Education (Business Schools), State Trade Agencies and Private Enterprise: A Model and Method for Scaling Global Trade

&nbsp; In 2015, the Governor of the Commonwealth of Virginia, Mr. Terry McAuliffe, accepted the advice of&nbsp; companies that were located in Virginia who said&nbsp; they could use state support to export their goods and services.&nbsp;From this discussion, a the Virginia International Trade Alliance (VITAL) was created to help those companies expand and succeed in the international marketplace (see - https://augustafreepress.com/governor-mcauliffe-announces-creation-of-virginia-international-trade-alliance/ ) This initiative is now&nbsp; managed by Virginia’s Department of Commerce&nbsp; (through its economic development agency, known as the Virginia Economic Development Partnership - VCDP). &nbsp;&nbsp;Over the last 5 years, in partnership with Virginia private businesses, the state’s Chamber of Commerce, and Virginia’s public institutions of higher education, the program has created public-private partnerships that benefit – 1) &nbsp;large, medium and small companies (with strategic access to global markets), 2) public universities (particularly participating business schools that are educating the next generation of savvy international business managers), and 3) Virginia itself (with more tax revenues realized from enhance international trade, more jobs related to such trade, and more awareness of the Virginia “brand” around the world, as traded goods and services from Virginia become better known and appreciated). &nbsp;In short, meaningful and well thought out public-private partnerships have led &nbsp;to&nbsp; “win-win” realities for all involved .&nbsp; Virginia Commonwealth University School of Business (VCU-SB) has participated in this program (along with 9 other public Virginia universities) since the inception of VITAL, and to-date the VCU-SB has undertaken over 25 graduate business student VITAL projects (see - https://business.vcu.edu/centers-institutes-and-labs/center-for-international-business-advancement/ ).&nbsp; Each project has focused on analyzing and selecting international markets for private Virginia companies, and advising them with respect to marketing strategies in promising global markets.&nbsp; This has all taken place, &nbsp;while also educating VCU-SB’s participating graduate students on the nuances of global market analysis, and strategies and management practices related to global business success. This conceptual paper represents an overview of how VITAL projects are selected, researched and completed.&nbsp; The paper provides series of figures to highlight &nbsp;the theory, practice and necessary steps related to VITAL’s success.&nbsp; The paper concludes with a call for other states and other countries to create their own form of VITAL (in general, labeled Vibrant International Trade Alliances) &nbsp;and to extend the underlying partnerships that this model represents to like-minded entities around the world. &nbsp;The overall objective is &nbsp;to develop a global network of public/private linkages to scale global trade even further.&nbsp

Nursing Students Behind Bars

With a large incarcerated patient population in the United States, there is a unique potential for clinical learning for undergraduate nursing students with this population. The Virginia Commonwealth University (VCU) School of Nursing and VCU Health System have created a unique partnership in which baccalaureate nursing students complete their first clinical rotation on VCU Health System's Secure Care Unit (SCU). At the conclusion of their semester, baccalaureate students assigned to the SCU for the fundamentals clinical were asked to provide feedback on their experiences. Both challenges and positive outcomes were identified by students who completed their first clinical rotation providing care to this unique population. The formation of this relationship between the VCU School of Nursing and the VCU Health System's SCU is helping to meet patient, student, and clinical unit needs and also making a positive impact on the stakeholders involved. [J Nurs Educ. 2021;60(8):470-471.].

A Question of Scale? Generalizability of the Ottawa and Chen Scales to Render Entrustment Decisions for the Core EPAs in the Workplace.

Assessments of the Core Entrustable Professional Activities (Core EPAs) are based on observations of supervisors throughout a medical student's progression toward entrustment. The purpose of this study was to compare generalizability of scores from 2 entrustment scales: the Ottawa Surgical Competency Operating Room Evaluation (Ottawa) scale and an undergraduate medical education supervisory scale proposed by Chen and colleagues (Chen). A secondary aim was to determine the impact of frequent assessors on generalizability of the data. For academic year 2019-2020, the Virginia Commonwealth University School of Medicine modified a previously described workplace-based assessment (WBA) system developed to provide feedback for the Core EPAs across clerkships. The WBA scored students' performance using both Ottawa and Chen scales. Generalizability (G) and decision (D) studies were performed using an unbalanced random-effects model to determine the reliability of each scale. Secondary G- and D-studies explored whether faculty who rated more than 5 students demonstrated better reliability. The Phi-coefficient was used to estimate reliability; a cutoff of at least 0.70 was used to conduct D-studies. Using the Ottawa scale, variability attributable to the student ranged from 0.8% to 6.5%. For the Chen scale, student variability ranged from 1.8% to 7.1%. This indicates the majority of variation was due to the rater (42.8%-61.3%) and other unexplained factors. Between 28 and 127 assessments were required to obtain a Phi-coefficient of 0.70. For 2 EPAs, using faculty who frequently assessed the EPA improved generalizability, requiring only 5 and 13 assessments for the Chen scale. Both scales performed poorly in terms of learner-attributed variance, with some improvement in 2 EPAs when considering only frequent assessors using the Chen scale. Based on these findings in conjunction with prior evidence, the authors provide a root cause analysis highlighting challenges with WBAs for Core EPAs.

Supplementing the Subinternship: Effect of E-Learning Modules on Subintern Knowledge and Confidence

Supplementing the Subinternship: Effect of E-Learning Modules on Subintern Knowledge and Confidence

Finding the Yes Through a Thousand Points of No:: Quality Improvement in an Academic Medical Center

Quality improvement (QI) initiatives are integral to improving health care delivery in academic medical centers (AMCs), and evidence-based QI is the gold standard for the provision of safe and compassionate health care. Despite this, there is a lag in translating evidence into practice. This article addresses the reasons why QI is challenging to implement in AMCs and provides strategies to overcome the barriers. QI is possible, and it is essential to focus the provider's energies on implementing positive change in AMCs. Quality improvement (QI) initiatives are integral to improving health care delivery in academic medical centers (AMCs), and evidence-based QI is the gold standard for the provision of safe and compassionate health care. Despite this, there is a lag in translating evidence into practice. This article addresses the reasons why QI is challenging to implement in AMCs and provides strategies to overcome the barriers. QI is possible, and it is essential to focus the provider's energies on implementing positive change in AMCs. Lesley Coots, DNP, FNP-BC, FNP-C, CCRN, is a Nurse Practitioner at the Division of Plastic & Reconstructive Surgery, VCU Health, in Richmond, Virginia. She can be reached at [email protected] . Jeanette Amery, DNP, AGACNP-BC, is a Nurse Practitioner at the Division of Transplant Surgery, VCU Health. Christine Schaeffer, DNP, ACCNS-AG, CEN, TCRN, is a Nurse Clinician at the Adult Emergency Department and Clinical Decision Unit, VCU Health, Pamela Parsons, PhD, GNP-BC, FNAP, is a Clinical Associate Professor, and Associate Dean for Practice and Community Engagement, and Judith B. Collins and Joseph M. Teefey Distinguished Professor at Virginia Commonwealth University School of Nursing in Richmond, and Shelly Smith, DNP, ANP-BC, is a Clinical Associate Professor and Director of the DNP Program at the Virginia Commonwealth University School of Nursing in Richmond.

In memoriam: Robert T. Leshner, MD

In memoriam: <scp>Robert T. Leshner</scp>, <scp>MD</scp>

Editorial introductions.

Editorial introductions.