Year Of Graduate School Research Articles

Oncologists’ management of non-cancer conditions: An observational study.

23 Background: Cancer diagnoses introduce layers of complexity for care coordination. Oncologists often find themselves independently managing coincident, non-cancer illnesses. How often oncologists engage in direct management of non-cancer conditions, rather than coordinating with patients' other providers, is not well understood. We examined how often oncologists prescribe medications to manage non-oncologic conditions, as a proxy for assuming primary-care responsibilities. Methods: The cohort included all US physicians with a specialty of Hematology-Oncology or Medical Oncology from 2016-2020, available in the Centers for Medicare & Medicaid Services Part D Prescribers dataset. Prescription drugs were categorized as “cancer-directed”, “cancer-related” (eg., opioid pain medications), or “non-cancer” (eg., antihypertensives). Primary outcomes included prescription of cancer-directed, non-cancer, and cancer-related medications. Multivariate logistic regression assessed the association between non-cancer medication prescriptions and provider location, medical school graduation year, gender, and practice affiliation during 2020. Results: A mean of 8.3% (median 5.3%, IQR 0% – 12.5%) of oncologists’ prescriptions were for non-cancer medications; this decreased during the study period, falling from 9.5% in 2016 to 7.4% in 2020 (p<0.001 on Kruskal Wallis test for non-parametric data). Providers practicing in the Midwest (aOR 1.3, 95%CI [1.2-1.5]), Southeast (1.5 [1.3-1.7]), and Southwest (1.6 [1.4-1.9]) were more to prescribe non-cancer medications, as were providers who graduated >10 years prior to the end of the study period, most notable in providers graduating 1990–1991 (2.2 [1.9-2.6]). Those at academic institutions (0.7 [0.6-0.8]) were less likely to prescribe non-cancer medications. Conclusions: A small but substantive portion of oncologists’ prescriptions are for medications unrelated to cancer care. The downtrend in non-cancer prescriptions may reflect that coordinated co-management of patients with cancer is increasing. The rise in telemedicine and digital health represents an opportunity to establish stronger multidisciplinary care for patients with cancer through hybrid cross-collaboration between primary care physicians and oncologists. This is especially advantageous in regions where in-person integration of physician groups may not be possible. Additionally virtual continuing medical education sessions may aid primary care physicians in managing non-cancer medications for the cancer population. Trends in oncologists’ prescribing patterns from 2016–2020: Mean per-provider proportion of non-cancer medication prescription (%). Medication Class 2016 2017 2018 2019 2020 Cancer-Directed 30.4 31.1 32.2 32.7 33.9 Non-Cancer 9.5 8.9 8.2 7.6 7.4

Application of PBL-CBL and Mini-CEX methods in the standardized training of residents in nephrology department: A prospective study.

This study explores the application and feasibility of problem based learning (PBL), integrating case based learning (CBL), and the mini clinical evaluation exercise (Mini-CEX) into the standardized training of residents in nephrology department, in order to assess their clinical skills in a comprehensive manner. This prospective study enrolled 60, three years residents majoring in clinical medicine, from June 2022 to December 2023 in Nephrology Department of Baoding No.1 Central Hospital. These participants were randomly allocated into either the combined PBL-CBL and Mini-CEX teaching group (experimental group) or the traditional lecture-based teaching group (control group). Two groups were evaluated with Mini-CEX assessments and test scores upon exit the department, followed by a questionnaire survey to measure satisfaction levels for the teachers. There was no statistically significant difference in age, sex, year of graduate school, specialty and student source between the two groups of residents upon the entering the department (P>0.05). Upon the completion, the experimental group, which received PBL-CBL and Mini-CEX teaching methods, demonstrated significantly higher scores in all aspects compared to the control group, with a statistically significant difference (P<0.01). Furthermore, compared the control group, most residents in the experimental group agreed that the PBL-CBL and Mini-CEX teaching methods improve curiosity and enthusiasm for learning (73.3%), communication and expression abilities (73.3%), self-learning abilities (80%), understanding of diseases (76.7%), and like this teaching method (86.7%). PBL-CBL and Mini-CEX may be an effective method for improving medical residents' performance and enhancing their clinical skills, which is worthy of promotion in the standardized training of the residents.

Can coaching bridge the gap for incoming Latinx graduate students?

ABSTRACT Attrition rates in the first two years of graduate school are high and ∼50% higher for underrepresented students. Here we evaluate an online group coaching intervention using a controlled and an experimental group to determine its impact on skills that are likely predictors of student success, namely the Hallmark of Success indices developed by the National Institutes of Health (NIH). Our intervention includes eight online coaching sessions (four prior to the first year of graduate school and four during the first year of graduate school). Coaching group sessions, led by certified coaches, address Resilience, Risk and Protective Factors, Accountability, Leadership, Teamwork, Professional Networking, and Self-Assessment. We evaluated the change in Hallmark of Success indices with a pre- and post-questionnaire of 44 items used to assess students’ self-evaluation in nine areas. Students in the experimental coaching group showed a significant increase in the Hallmark of Success indices in seven out of nine areas of student performance between the pre- and post-questionnaires compared to the null model of no changes between time periods. In addition, in all of the nine indices of success, we noted significant differences between the pre- and post-surveys for the experimental group. Our experimental design shows that our cost-effective coaching model improves student performance as perceived by the students.

Predicting Peak Productivity in Urologic Medicare Practice via Work-Relative Value Units

ObjectivesTo explore factors associated with productivity in urologic practice. Work-relative value units (wRVUs), the basis for Center for Medicare & Medicaid Services (CMS) and private payer reimbursements, commonly serve to estimate physician productivity. Limited data describes which practice factors predict increased wRVU productivity. MethodsThe 2017 and 2018 CMS databases were retrospectively queried for urologic Medicare provider demographics and procedural/service details. Medical school graduation year was used to estimate years in practice and generation (Millennial, Gen X, Baby Boomer, or Post-War). Treated patients’ demographics were obtained. Adjusted and unadjusted linear mixed models were performed to predict wRVU production. ResultsIncluded were 6,773 Medicare-participating urologists across the United States. Millennials produced 1115 wRVUs per year, while Gen X and Baby Boomers produced significantly more (1997 and 2104, respectively, p<.01). Post-War urologists produced numerically more (1287, p=.88). In adjusted analyses, predictors of Medicare wRVU productivity included FPMRS (exponentiated beta estimate (β) 1.46, 95% CI 1.32-1.60), men’s health (β 1.22, 95% CI 1.13-1.32), and oncologic sub-specialization (β 1.08, 95% CI 1.02-1.14), female gender (β 0.87, 95% CI 0.82-0.92), wRVUs generated from inpatient procedures (β 1.08, 95% CI 1.06-1.09) and office visits (β 0.88, 95% CI 0.87-0.89), and the level of education (β 1.10, 95% CI 1.07-1.14) and percent impoverished patients (β 0.85, 95% CI 0.83-0.88) in provider’s practice zip code. ConclusionsUrologic experience, specialization, demographics, practice patterns, and patient demographics are significantly associated with wRVU productivity in Medicare settings. Further work should incorporate quality metrics into wRVUs and ensure patient demographics do not affect reimbursement.

“Hot hoes” and “dirty whites”: racial contestation and fetishization of multiracial and contested white women

The fear of race-mixing through procreation has been strategically propagated in the Unites States as a force for social control, even though interracial intimacies have taken place since the 1600s. Fetishization can be considered an inversion of that fear. In contemporary times, the college and graduate school years constitute seasons wherein individuals learn from interpersonal, romantic, and sexual relationships, and both fear of race-mixing and fetishization show up in this arena. This manuscript considers the narratives of 14 contested white cis women students at a predominantly white postsecondary institution and delineates the construction of the paradoxical “Hot hoe/Dirty white” subjectivity through discourse. The discourses of white supremacy shape the experiences of postsecondary students, ordering romantic and sexual possibilities and engendering subjectivity. Considering racialized subjectivity through discourse illuminates the role of hegemonic norms and adds important insights to contemporary, widespread developmental models of racial identity extant in social science literature.

"Your Family is Always With You": Perceptions of Parental Relationships Among Hispanic/Latinx Young Adults Pursuing STEM Careers.

Hispanic/Latinx young adults remain significantly underrepresented in science, technology, engineering, and mathematics (STEM) fields, yet the role families play in these young adults' trajectories in STEM is still underexamined. The purpose of this study was to examine the relational supports and constraints that Hispanic/Latinx college students in STEM majors experienced with their parents as they moved through college and transitioned into their first year of graduate school or full-time employment. Two rounds of interviews were conducted with 18 Hispanic/Latinx young adults who were part of an undergraduate STEM program at a Hispanic-majority university. Most of the study participants reported benefiting from immense emotional support from their parents; however, this emotional support was often simultaneously coupled with home-school value conflicts and a dynamic we call "conversational constraints." Results from this study point to important interventions involving family that might improve the rates of participation of Hispanic/Latinx students from a range of socioeconomic backgrounds in STEM fields.

Response time of high impact factor medical journals versus an expert-curated, online oncology platform before and during the COVID-19 pandemic.

465 Background: The objective of this study was to characterize the publication speed of high impact factor medical journals (HIFMJ) compared with the dissemination speed of a private, expert-curated, online platform (ECOP) designed for oncologists. We also aimed to describe determinants of response speed to questions on this platform. Methods: We selected 100 HIFMJ and calculated their reported peer review time (Submission to Acceptance [STA]). The platform database was queried between the dates 2017 and 2022 with information collected about day of query, response time (RespT), and poster gender, region, and medical school graduation year. This data was analyzed utilizing univariable median regression analyses and two t-tests as appropriate. Results: Of the 26 available medical journal response times, the average STA was 57.36 days (range: 2.6 - 204 days). Of the 4,346 online platform questions and answers (Q+A), the mean RespT was noted to be significantly lower at 2.63 days (CI, 2.19 - 3.07 days). With the ECOP, the mean RespT for male posters (mean: 2.58 days; CI, 2.08 - 3.08) and female posters (mean: 2.72 days, CI, 1.89 - 3.56) was not significantly different (p=0.61). RespT from 2017 to 2019 increased slightly (p&lt;0.001) before trending down during the COVID pandemic (p&lt;0.02). Mean RespT before the Covid pandemic in the United States, March 15, 2020 (2.68 days, CI, 2.11 - 3.25), was non-significantly reduced as compared with questions after March 15, 2020 (2.17 days, CI, 1.88 - 2.46, p=0.13). Conclusions: Traditional peer review proves a lengthy process in contrast to real-time, Q+A-based oncology platforms. An ECOP allows physicians the ability to provide their expertise regarding rare, nuanced patient cases in order to better ensure all patients receive the highest level of clinical care. During the onset of the COVID-19 pandemic, the ability to share medically curated information to ensure safe and effective oncologic care in a timely manner proved imperative, as information regarding the virus was evolving rapidly. During this unprecedented time, this platform provided oncologists with a novel way to quickly vet case reports and disseminate scientific information. This, in turn, translated into cancer care “best practices” during a rapidly evolving crisis.

University Student Dropout Prediction Using Pretrained Language Models

Predicting student dropout from universities is an imperative but challenging task. Numerous data-driven approaches that utilize both student demographic information (e.g., gender, nationality, and high school graduation year) and academic information (e.g., GPA, participation in activities, and course evaluations) have shown meaningful results. Recently, pretrained language models have achieved very successful results in understanding the tasks associated with structured data as well as textual data. In this paper, we propose a novel student dropout prediction framework based on demographic and academic information, using a pretrained language model to capture the relationship between different forms of information. To this end, we first formulate both types of information in natural language form. We then recast the student dropout prediction task as a natural language inference (NLI) task. Finally, we fine-tune the pretrained language models to predict student dropout. In particular, we further enhance the model using a continuous hypothesis. The experimental results demonstrate that the proposed model is effective for the freshmen dropout prediction task. The proposed method exhibits significant improvements of as much as 9.00% in terms of F1-score compared with state-of-the-art techniques.

Reconceptualizing Response to Writing from a Longitudinal Perspective: Writing Development and Dialogic Interaction

Resumen Given the amount of time writing instructors spend in providing feedback on writing, researchers have sought to understand many dimensions of feedback, especially the practices that best support student writing development. A number of researchers have sought to understand student perspectives on response to writing, and this study builds on that work by examining student perceptions of responses to writing from a longitudinal perspective. This interview-based study draws on data from college students who were interviewed once each year for five years (four years of undergraduate education and a fifth year in graduate school or the workplace). Conducted at a major private university in the United States, this article draws its data from a five-year longitudinal study of 189 college students (a random sample of 12% of the incoming freshman class) that collected student’s writing in and out of class, and included semi-structured interviews with a subgroup of 39 students once each year during the five-year period. The interviews focused on the students’ writing lives and investigated many aspects of their writing experience both in and out of school. This article presents an analysis of their perceptions of factors that contributed to their development as writers, especially feedback, as the initial coding of the interview data showed that feedback was by far the most influential contributor to student’s writing development. Further analysis of the interviews focused on understanding the who, what, when, where, why, and how of feedback, that is, the analysis sought at a fine-grained level to understand the ways and degree to which feedback contributed to student’s growth as writers. Elements of theories of dialogism and dialectic were particularly useful in highlighting the features of effective responses to writing; specifically, the idea that the most impactful forms of feedback took place when there were frequent and ongoing dialogues between a writer and a responder with a particular set of characteristics. These types of conversations were particularly impactful when conducted with peers outside of classroom settings. Results suggest that future researchers on feedback should look beyond individual instances of feedback to ongoing chains of communication, and to seek to understand the ways in which writers integrate feedback into their writing practices. Results also showed that feedback from peers outside of classroom settings were highly influential on students’ sense of their own writing development. Implications for research and teaching are discussed. Specifically, it is suggested that teachers and those responsible for writing pedagogy are encouraged to consider ways in which they can facilitate multiple, ongoing streams of high-quality feedback for their students, and to prioritize these conversations in their instructional practice and writing pedagogies. Keywords language instruction, writing, learning processes, feedback, literacy methods

MP72-08 PREDICTING PEAK PRODUCTIVITY IN UROLOGIC PRACTICE VIA WORK-RELATED VALUES

You have accessJournal of UrologyCME1 Apr 2023MP72-08 PREDICTING PEAK PRODUCTIVITY IN UROLOGIC PRACTICE VIA WORK-RELATED VALUES Logan Briggs, Jamie Ye, Muhieddine Labban, Peter Herzog, David-Dan nguyen, Christopher J.D. Wallis, Christopher Wolter, and Quoc-Dien Trinh Logan BriggsLogan Briggs More articles by this author , Jamie YeJamie Ye More articles by this author , Muhieddine LabbanMuhieddine Labban More articles by this author , Peter HerzogPeter Herzog More articles by this author , David-Dan nguyen David-Dan nguyen More articles by this author , Christopher J.D. WallisChristopher J.D. Wallis More articles by this author , Christopher WolterChristopher Wolter More articles by this author , and Quoc-Dien TrinhQuoc-Dien Trinh More articles by this author View All Author Informationhttps://doi.org/10.1097/JU.0000000000003340.08AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookLinked InTwitterEmail Abstract INTRODUCTION AND OBJECTIVE: There are limited data on which physician and practice factors are associated with increased productivity. Work-relative value units (wRVUs), the basis for the Center for Medicare & Medicaid Services (CMS) and private payers’ reimbursements, are commonly used to estimate physician productivity. We aimed to determine what factors are associated with urologic wRVUs productivity. METHODS: The CMS database from 2017 to 2018 was retrospectively queried for urologic Medicare provider demographics and procedural/service details. Urologists’ medical school graduation year was used to estimate years in practice and urologist’s generation (Millennial, Gen X, Baby Boomer, or Post-War). Treated patients’ demographics were obtained. Adjusted and unadjusted linear mixed models were performed to predict Medicare specific wRVU production. RESULTS: A total of 6,773 practicing urologists (8.8% female) across the US were included: 10.1% Millennials, 44.6% Gen X, 39.8% Baby Boomers, and 5.6% Post War urologists. Additionally, 57% were general, 18% were oncologic, 17% were endo/MIS, 4.4% were men’s health, 3.2% were FPMRS, and 0.4% were reconstructive urologists. Millennial, Gen X, Baby Boomer, and Post-War urologists produced 1115, 1997, 2104, and 1287 Medicare wRVUs per year, respectively. In adjusted analyses, predictors of wRVU productivity included Gen X and Baby Boomer generations, FPMRS, men’s health, and oncologic sub-specialization, male gender, generating more wRVUs from inpatient procedures and less from office (especially new-patient office) visits, and seeing fewer educated and impoverished patients. CONCLUSIONS: The most significant predictor of urologists’ productivity is practice experience, which follows a bell curve over time that peaks 20 to 35 years after graduation; the average Gen X or Baby Boomer urologist produced nearly double the annual Medicare wRVUs of Millennial or Post-War urologists. Further work is needed to incorporate quality metrics into wRVUs or reimbursements, and to ensure that patient demographics do not affect or predict reimbursement. Source of Funding: None © 2023 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 209Issue Supplement 4April 2023Page: e1027 Advertisement Copyright & Permissions© 2023 by American Urological Association Education and Research, Inc.MetricsAuthor Information Logan Briggs More articles by this author Jamie Ye More articles by this author Muhieddine Labban More articles by this author Peter Herzog More articles by this author David-Dan nguyen More articles by this author Christopher J.D. Wallis More articles by this author Christopher Wolter More articles by this author Quoc-Dien Trinh More articles by this author Expand All Advertisement PDF downloadLoading ...

Artificial Goods: Credentialism and Student Affairs Professional Development

Artificial Goods:Credentialism and Student Affairs Professional Development Laila I. McCloud (bio) and Niki Messmore (bio) Because of ongoing pessimism and frustration with the increased work expectations that do not correlate with increased financial compensation, student affairs professionals are left wondering what the future of student affairs is (21st Century Task Force, 2020). Graduate preparation programs and professional associations that have maintained their position as significant socialization agents for the field (Duran & Allen, 2020; Perez, 2016) are also wrestling with this question. Many student affairs professionals spend several years in graduate school being socialized into ways of being, thinking, and doing that often perpetuate whiteness. This socialization shows up in the classroom where faculty position graduate Students of Color as the experts on race-related issues (Harris & Linder, 2018) while failing to encourage racial identity development among white graduate students (Briscoe & Jones, 2022). This socialization continues as educators become enmeshed in their institution's culture. When these graduate students transition into full-time employment, the positioning of particular groups of people as experts on certain issues will follow them. The presumption of expertise on certain topics (e.g., anything diversity related) carries over into the availability of professional development opportunities. In recent years, opportunities for student affairs educators to pursue professional development have increased. These opportunities include pursuing additional degrees (e.g., a master's or doctoral degree or certificates) or learning experiences sponsored by professional associations (e.g., conferences, C.E.Us., or certificates). However, these opportunities come with physical and financial costs that need to be collectively assessed and evaluated by professionals and faculty compared to their effectiveness in enhancing student affairs practice and improving the quality of life for student affairs educators. Graduate preparation programs and professional associations have pushed practitioners and faculty to think about the role of credentialism in perpetuating whiteness, neoliberalism, and labor inequity that fuel our current evolution. THE ROLE OF ARTIFICIAL GOODS For this conversation, we understand credentials as any formal education deemed necessary or helpful for career advancement and social mobility. Credentialism perpetuates inequality in that individuals in senior-level positions operate as gatekeepers by controlling who has access based upon what Collins (2019) referred to as an "artificial good" (p. 243). Certificates [End Page 246] become an artificial good as they are used to demonstrate that a student affairs professional has more education, not that they are more skilled or knowledgeable. In this case, the increasing call for more skilled workers pushes student affairs educators to obtain additional educational currencies in a highly stratified labor market. Student affairs professionals are also in a unique position because their place of employment is both a site and guarantor of information production (Walters, 2004). We exist in a system that promotes credentialism while also seeing it as tied to our own success and credibility. We will explore these credentialing initiatives from our perspectives as a Black woman faculty member in a higher education and student affairs (HESA) graduate program and a White woman, mid-level student affairs professional. WHO'S CREDENTIAL IS IT? Contemporary social issues have pulled our attention to how whiteness dictates the entry into and movement within the student affairs profession. For example, the COVID-19 pandemic prompted many highly rejective graduate programs to eliminate their reliance on standardized testing to grant admission. The question remains whether the decision to eliminate the testing requirements was about disrupting whiteness or a response to limited opportunities to complete the test. Once students are enrolled in the program, faculty spend a significant amount of time assuaging students' concerns about their professional futures. Graduate students receive messages that they should know the functional area they want to work in for the rest of their careers. However, students who are racially marginalized often comment that they worry about having future career opportunities limited if they pursue certain functional areas. This worry is exacerbated by students' social locations and the organizational structure of student affairs divisions, which promote siloing of student identity and development. Two issues arise from this siloing as it relates to credentialing. First, the presence of certificates for particular functional areas perpetuates the idea that there is a particular way of doing the...

Physician-Peer Relationships and Patient Experiences With Specialist Care

Peer relationships may motivate physicians to aspire to high professional standards but have not been a major focus of quality improvement efforts. To determine whether peer relationships between primary care physicians (PCPs) and specialists formed during training motivate improved specialist care for patients. In this quasi-experimental study, difference-in-differences analysis was used to estimate differences in experiences with specialist care reported by patients of the same PCP for specialists who did vs did not co-train with the PCP, controlling for any differences in patient ratings of the same specialists in the absence of co-training ties. Specialist visits resulting from PCP referrals from 2016 to 2019 in a large health system were analyzed, including a subset of undirected referrals in which PCPs did not specify a specialist. Data were collected from January 2016 to December 2019 and analyzed from March 2020 to October 2022. The exposure was PCP-specialist overlap in training (medical school or postgraduate medical) at the same institution for at least 1 year (co-training). Composite patient experience rating of specialist care constructed from Press Ganey's Medical Practice Survey. Of 9920 specialist visits for 8655 patients (62.9% female; mean age, 57.4 years) with 502 specialists in 13 specialties, 3.1% (306) involved PCP-specialist dyads with a co-training tie. Co-training ties between PCPs and specialists were associated with a 9.0 percentage point higher adjusted composite patient rating of specialist care (95% CI, 5.6-12.4 percentage points; P < .001), analogous to improvement from the median to the 91st percentile of specialist performance. This association was stronger for PCP-specialist dyads with full temporal overlap in training (same class or cohort) and consistently strong for 9 of 10 patient experience items, including clarity of communication and engagement in shared decision-making. In secondary analyses of objective markers of altered specialist practice in an expanded sample of visits not limited by the availability of patient experience data, co-training was associated with changes in medication prescribing, suggesting behavioral changes beyond interpersonal communication. Patient characteristics varied minimally by co-training status of PCP-specialist dyads. Results were similar in analyses restricted to undirected referrals (in which PCPs did not specify a specialist). Concordance between PCPs and specialists in physician age, sex, medical school graduation year, and training institution (without requiring temporal overlap) was not associated with better care experiences. In this quasi-experimental study, PCP-specialist co-training elicited changes in specialist care that substantially improved patient experiences, suggesting potential gains from strategies encouraging the formation of stronger physician-peer relationships.

IN MEMORIAM: Terry T. Marsh (25 July 1938 – 30 July 2021)

Asian Perspectives, Vol. 62, No. 2 © 2023 by the University of Hawai‘i Press. IN MEMORIAM Terry T. Marsh (25 July 1938 – 30 July 2021) Terry Marsh excavating at Spirit Cave, Thailand, in early March 1971 (Photograph by Chet Gorman, courtesy of Joyce White and the Institute for Southeast Asian Archaeology, University of Pennsylvania Museum) On 30 July 2021, Terry T. Marsh passed away at the age of 83 at his home in Auckland, New Zealand. An archaeologist who was as ubiquitous as he was mystic, Marsh had participated in excavations and research at some of the best-known sites in mainland Southeast Asia during the late 1960s and early 1970s. Although he published only a few archaeological reports, his interest, kindness, friendship, and dedication made a significant contribution to our knowledge of Thailand and mainland Southeast Asian prehistory. Marsh attended undergraduate school at Sacramento State College (now California State University, Sacramento) in 1958 – 1962. He graduated in spring 1962 with a B.A. in Fine Arts, specifically ceramics. It was during college that Marsh became friends with Chester “Chet” F. Gorman. They were housemates, along with several other students, in a rented home near campus. Although Marsh did not formally graduate with an anthropology degree from Sacramento State College, his journey to archaeology, anthropology, and Thailand began almost immediately after graduation. In spring 1962, Gorman had just finished his first year of graduate school in the Department of Anthropology, University of Hawai‘i when he sent Marsh a telegram that simply Early online release of article in press. stated: “SUMMER WORK CAVE EXPLORATION OUTER ISLANDS COME IMMEDIATELY.”1 Marsh answered the call, and his journey to Southeast Asia began. While in Hawai‘i, Marsh surveyed lava tubes with Gorman as part of a U.S. government project investigating the use of these caves as nuclear fallout shelters. Once their survey was completed, presumably in 1962, Marsh later wrote in an unpublished personal memoir that he “sort of forgot to go home.” He continued working in survey for the same company on various projects throughout the islands. After Gorman returned from his first season of archaeological survey in northeast Thailand in 1964, he and Marsh began living in another rented, shared house infamously known as “Sutton’s Place.” For all its raucousness, living at Sutton’s Place put Marsh in contact with several other anthropologists and archaeologists who were colleagues or friends of Gorman’s at the University of Hawai‘i. One of these housemates-turned-friends was an archaeologist named Donn Bayard. Given Marsh’s background in ceramics and experience working in survey throughout Hawai‘i, it was no surprise that Bayard asked Marsh to assist him when he returned to northeast Thailand in 1968 for the second season of archaeological excavation at a prominent site called Non Nok Tha. Marsh’s travel to northeast Thailand was an adventure. Excavations began at Non Nok Tha in early February 1968, so Marsh likely left Hawai‘i in late 1967 or January 1968. Either way, after booking a berth on a passenger ship from Honolulu to Hong Kong, he immediately became seasick. Medicine helped – after an initial refusal to take it which he blamed on being “a young male” – but Marsh later recalled that the vessel would roll so violently that the swimming pool would slosh and spill over the sides of the ship. Marsh also noted that the vessel had a herd of cattle in the hold which he enjoyed visiting. He also enjoyed later eating them during any one of the six daily meals served on the ship. Marsh’s memoirs and notes are full of food descriptions – he clearly enjoyed eating, trying new experiences, and immersing himself in new cultures. His flair for writing helped capture these moments. After arriving in Hong Kong, Marsh caught another passenger ship which was sailing for Singapore, but once landed, decided that, since he “was on the same landmass as Thailand,” it would be possible to buy a Honda 90 motorbike and ride north. Marsh was able to cross the SingaporeMalaysian border without incident, but once he reached the border with Thailand his fortunes changed. He was not allowed to cross and...

Supremely Influential: How The Man That Once Was Whizzer White Shaped My Career

Supremely Influential:How The Man That Once Was Whizzer White Shaped My Career Helen J. Knowles-Gardner (bio) "He graduated from Yale Law School; he served in the Navy in World War II; and he was a Rhodes Scholar at Oxford University …" Introducing my "law and courts" students to the extraordinary biography of Byron R. White usually begins with these observations. Although this summary of his accomplishments is traditionally prefaced with a statement saying that White had a "résumé you pretty much can't beat," I still have not captured my students' attention. Yale Law seems several worlds away for them; World War II is ancient history; and they have no idea what a Rhodes Scholar is. So, I continue. "Deputy Attorney General during the presidency of John F. Kennedy; and then one of Kennedy's appointments to the Supreme Court of the United States in 1962, serving on that Court until 1993." Some of the students are now impressed. "Oh," I then casually remark, "and he played in the N.F.L." Now I have the attention of all of the students, attention generally confirmed with numerous exclamations of "whoa" or "say what?" While I love bringing Justice Byron R. White to life in this manner, I always feel rather ashamed at doing so. Ashamed, because I have the distinct feeling that White is sitting in the corner of the classroom politely trying not to roll his eyes in frustration that yet another person has capped off their description of his lifetime of accomplishments with reference to his athletic achievements. In 1935, a Denver Post journalist "saddled" the rising college football star White "with a name he did not seek, did not like, and could not shake."1 Much to White's dismay, [End Page 95] the name "Whizzer White"—and all that it embodied—stuck with him, through thick and thin. Far too frequently journalists were wont to undermine (not necessarily deliberately, sometimes just carelessly) the man's legal, political, and judicial accomplishments by reminding their readers of the notable fact that "Whizzer" White had once been a standout on the gridiron. My shame does not last long, however, for the simple reason that "Justice of the Supreme Court of the United States and N.F.L. player" is a unique biographical description that has, over the years, etched itself into the memories of my students, and captivated their attention, just like it did for me during the winter of 2000. I was in my first year of graduate school, and had very quickly reached the conclusion that studying Supreme Court politics and history was my educational raison d'être. At the end of my first semester, I sought out suitable winter break reading material at the local bookstore. Little did I know that one of my purchases was a book that would have a truly significant influence on my career. The book captivated my attention and burned one of its central arguments (and a good many anecdotes and useful pieces of information) into my memory in a way very few books have ever done (and likely ever will). That aptly titled biography of White—The Man Who Once Was Whizzer White—(hereinafter referred to as Whizzer White), written by one of the Justice's former clerks, Dennis Hutchinson, is the book in question. At the end of the Prologue to that volume, Hutchinson recalls White's mid-career observation that, "[j]udges have an exaggerated view of their role in our polity."2 I do not have an "exaggerated view" of the "role" that Whizzer White has played in shaping and influencing my own research, scholarship, and teaching. It has been, and always will be supremely influential. An Influence On My Researching My original marginalia, circa January 2001, begin to appear in the pages of chapters eleven and twelve of my well-thumbed copy of Hutchinson's book (back then, I was less prone to extensive annotation and page corner-folding of volumes). There is one noticeable exception, however. A solitary, pencil-written exclamation point appears next to the paragraph at the top of page three. And it is there that we find the second thing...

A continuing clinical education course to maintain clinical competencies and foster new clinical knowledge during the graduate school years of MD-PhD training.

Most students in MD-PhD programs take a leave of absence from medical school to complete PhD training, which promotes a natural loss of clinical skills and knowledge and could negatively impact a student's long-term clinical knowledge. To address this concern, clinical refresher courses in the final year of PhD training have traditionally been used; however, effectiveness of such courses versus a longitudinal clinical course spanning all PhD training years is unclear. The University of Alabama at Birmingham MD-PhD Program implemented a comprehensive continuing clinical education (CCE) course spanning PhD training years that features three course components: (1) clinical skills; (2) clinical knowledge; and (3) specialty exposure activities. To evaluate course effectiveness, data from an anonymous student survey completed at the end of each semester were analyzed. Five hundred and ninety-seven surveys were completed by MD-PhD students from fall 2014 to 2022. Survey responses indicated that the majority of students found the course helpful to: maintain clinical skills and knowledge (544/597, 91% and 559/597, 94%; respectively), gain exposure to clinical specialties (568/597, 95%), and prepare them for responsibilities during clinical clerkships. During semesters following lockdowns from the COVID-19 pandemic, there were significant drops in students' perceived preparedness. Positive student survey feedback and improved preparedness to return to clinic after development of the course suggests the CCE course is a useful approach to maintain clinical knowledge during research training.

1305. PrEParing for success: An intervention to increase HIV prevention awareness among internal medicine residents.

Abstract Background PrEP (Pre-Exposure Prophylaxis) is a strategy that involves a combination of antiretrovirals medications aimed to reduce HIV transmission among at-risk individuals. The purpose of this quality improvement project is to increase internal medicine residents' knowledge and prescribing of PrEP. Methods We administered an anonymous paper survey to internal medicine residents at all stages of training at our suburban community hospital in the Hudson Valley, NY in the summer of 2021 during the academic half-day of their ambulatory block rotation. The survey consisted of questions about the residents’ demographics, PrEP knowledge, and previous prescribing of PrEP. Following the survey participants were given a 1-hour lecture by the authors on sexual history and PrEP including indications, available options, dosing, monitoring, side effects, and access to the therapy. Six months later we reissued the same survey to the residents. Surveys were analyzed using descriptive statistics. Results All 74 eligible residents completed the survey. Out of the 74, 35 (47.3%) identified as male and 40 (52.7%) identified as female. Medical school graduation year range between 2007 to 2021. Only 69 residents completed the post-survey. To Q1 “which medications are FDA approved to be used as PrEP,” 40 (54.05%) answered correctly prior to the intervention, whereas 51 (73.91%) did after. When they were asked Q3 “How effective was PrEP at reducing the risk of contracting HIV through sex,” 21 (28.38%) responded correctly, which improved to 46 (66.67%) after. To the other knowledge-based questions there was no significant improvement (see table). The number of people who reported prescribing PrEP increased from 2 (2.7%) to 7 (10.14%). PrEP survey Pre and Post results Conclusion Although experiencing this educational intervention did not improve long-term retention of knowledge among the participants, there was a substantial increase in the number of residents who prescribed PrEP. One of the limitations that can contribute to these results; is the short time frame between the intervention and post-survey. These findings demonstrate the need for early introduction of this topic into medical school and residency program curricula. Disclosures All Authors: No reported disclosures.

Coworker Reports about Unprofessional Behavior in Plastic Surgery.

Patient reports of unprofessional conduct by surgeons have been linked to postprocedure complications and increased risk for malpractice claims. Coworkers are also positioned to observe and report unprofessional behaviors, including concerns related to delivery of competent medical care, clear and respectful communication, integrity, and responsibility. This study compared rates of coworker concerns between plastic surgeons and other physicians (other surgical specialists and nonsurgeons), and characterized whether plastic surgery subspecialties differed in their rates of complaints. Coworker concern data from January 1, 2014, to December 31, 2019, were retrieved from the Vanderbilt Center for Patient and Professional Advocacy's Coworker Observation Reporting System database. Specialty was classified as plastic surgery, non-plastic surgical, and nonsurgical. The plastic surgery cohort was further characterized by sex, medical school graduation year, predominant practice type (reconstructive only, aesthetic only, or hybrid), and postresidency training (ie, completion of a fellowship). The study cohort included 34,170 physicians (302 plastic surgeons, 7593 non-plastic surgeons, and 26,275 nonsurgeons). A greater proportion of plastic surgeons (13.6%) had one or more coworker concerns compared with nonsurgeons (10.8%) and non-plastic surgeons (6.1%) ( P < 0.001). The most prevalent concern category reported for plastic surgeons was clear and respectful communication. Among plastic surgeons who had no concerns versus those who had at least one concern, there was no significant difference when comparing sex, medical school graduation year, predominant practice type, or postresidency training. Plastic surgeons in this cohort study received more coworker reports than other surgeons and nonsurgical physicians. These data may be used by institutions to identify plastic surgeons at risk for preventable postprocedure complications and intervene with peer feedback intended to promote self-regulation.

Notes on a Thesis by Tiphaine Rivière

Reviewed by: Notes on a Thesis by Tiphaine Rivière Rachel L. E. Klammer (bio) notes on a thesis Tiphaine Rivière Penguin https://www.penguin.com.au/books/notes-on-a-thesis-9781473557512 184 pages; Print, $14.99 Near the end of the second year of my PhD program, my peers and I spent a good chunk of time assembling our plans of study. The process was shrouded in mystery, mostly because the plan-of-study form required us to outline what courses we would take for the remainder of our years in graduate school, despite the fact that course offerings were only visible to students about a half-semester in advance. We turned in our plans of study with wild guesses and speculation. None of us knew how long approval from the graduate college would take, only that approval was needed to take our comprehensive exams. Months passed, the pandemic struck. About a year later, during a university holiday, I received a notification that my plan had been rejected, because "the courses taken did not match the courses outlined in the plan of study." No shit. I called the graduate college in a panic, as is the natural response of the graduate student. "I need this plan approved in the next four months in time for my exam. It took you a year to get back to me on the first plan, how long will the revisions take?!" Bob, a graduate student working for the graduate college, assured me I shouldn't worry about it. Once I'd submitted revisions, he said, I could just call and they can would expedite the process. But the process would not be so simple. I made the revisions and emailed my adviser to get her approval. She emailed me back the next day, telling me she could not approve the changes; the previous semester a member of my committee left the university, and I had not yet found a replacement. She could not sign off until a replacement was found. Time was short. I emailed a new faculty member who at the time was inundated with similar requests from students also attempting to replace said faculty member. I heard back [End Page 18] a month later, after a second prodding email. The instructor wanted to set up a meeting to discuss my request the following weekend. Time was short. My hair was falling out as it had continued to do since the start of my second year. By the time I sent in my revisions, I had but a few months to attain approval from the graduate college. I waited two weeks before I called them. "We can't expedite the approval process," Sandra told me. "We will process them in the order they are received. If you had a deadline you had to meet, you should have sent this in earlier." I employed my most powerful strategy: pitiful begging. "But I sent it in a year ago. If I don't get this approved, I won't be able to take my exam. I'll have to wait a whole year. I don't know what to do. Please, you have to help me!" Sandra told me to get bent. I was ruined. Oh, well. I found out the next day that the wording in the graduate handbook was misleading (or, more likely, that my reading comprehension skills were severely lacking) and that I did not need my plan of study approved to take my exams. I went home and drank. Such is graduate school. ________ Bureaucratic, meaningless struggles such as these are often the subject of the new campus novel, and they are the kind that Tiphaine Rivière manages to capture quite well in Notes on a Thesis. Jeanne Dargan is a PhD student without funding who is struggling her way through a degree in the humanities. She manages to secure a part-time job teaching medieval literature to undergraduates, a subject she knows nothing about. Ironically, at the end of term, her university refuses to pay her. They thought she had another full-time job and cannot pay out the part-time work unless Jeanne can prove...

Lower SES PhD students experience interpersonal disconnection from others both inside and outside of academia

AbstractStudents from lower socioeconomic status (SES) backgrounds can experience stigma in undergraduate educational settings but little research on this topic has been conducted at the PhD level. Lower‐SES PhD students may feel lower levels of social integration as they experience incidents of interpersonal disconnection from others inside and outside of academia. Interpersonal disconnection may be a mechanism by which lower‐SES leads to a lower sense of social integration. In this prospective study of first‐year PhD students at three North American universities (N = 608), we assessed students’ perceived social integration and their interpersonal perceptions inside and outside of academia 2–8 times throughout their first year of graduate school. Relative to higher‐SES students, lower‐SES students perceived lower levels of social integration. They had difficulty making academic friends, felt dissimilar to their academic peers, and perceived a lack of understanding about their work in graduate school from non‐academic families and friends. They also lost non‐academic social ties. These interpersonal disconnections prospectively mediated the association between lower SES and lower levels of perceived social integration. Lower‐SES PhD students are at risk of impaired interpersonal relationships. Institutional policies to promote social connections among PhD students may help lower‐SES students integrate into academia.

Bernard Bailyn on the Craft and Art of Historical Writing

Bernard Bailyn on the Craft and Art of Historical Writing