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Background Using correct pronouns is an impactful way to establish affirming environments for transgender and nonbinary (TGNB) patients. However, physicians often report struggling with this. Objective This study set out to conduct an initial root cause analysis of factors contributing to medical students and physicians failing to use TGNB patients’ correct pronouns. Methods A 10-item Qualtrics survey was sent to medical students, residents, and physicians practicing in Central Ohio. Participants were asked to describe perceived challenges or barriers colleagues have regarding correctly using TGNB patients’ correct pronouns. A directed content analysis of participant responses was performed utilizing a fishbone diagram root cause analysis tool as a basis for conceptualizing and categorizing barriers. All coding was completed by independent reviewers utilizing a consensus reconciliation methodology. Results Of 928 survey respondents, 763 met the study inclusion criteria, of which 453 provided analyzable responses. Of these 453, attendings with five or more years of practice (32.5%) and medical students (27.4%) made up the two largest demographic categories. 1.7% of respondents identified as transgender, nonbinary, and/or genderqueer, and 64% identified as heterosexual/straight. Five core barrier categories were identified: documentation, patient care, environment, knowledge, and individuals. Sub-categories were also identified, including lack of documentation, discomfort, medical culture, lack of standardization, prejudice, and assumptions. Conclusion The study identifies important barriers to medical professionals correctly using TGNB patients’ pronouns. The root cause analysis conducted as part of this study demonstrates the necessity of multi-pronged, system-level interventions to support ensuring TGNB patients are addressed using the correct pronouns.

Graduate medical education (GME) orientation/onboarding is conventionally an in-person activity, but the COVID-19 pandemic prompted virtual approaches to learner onboarding. However, online GME onboarding strategies have not been disseminated in the literature. To determine the usefulness of an online curriculum for GME learner orientation at a large sponsoring institution using an electronic survey. The primary outcome was to discover the usefulness of our online curriculum for GME onboarding, and secondary outcomes included identifying barriers to implementation and weaknesses associated with online GME orientation. We created an online GME orientation curriculum to onboard incoming learners (from June 1 to August 31, 2020) and electronically surveyed our learners to determine the usefulness of this novel approach. We conducted orientation sessions and electronically recorded questionnaire responses using CarmenCanvas, our institutional learning management system. Linear regression analysis was performed to identify factors predicting satisfaction with virtual GME orientation using IBM SPSS Statistics, Version 26.0 (Armonk, NY, USA). Of 353 trainees, 272 completed the survey for a 77% response rate. 97% of respondents reported that the curriculum supported performance of learner duties. 79% of trainees perceived the overall quality as \"very good\" or \"good\", 91% responded that the curriculum provided \"effective learning\", 94% reported \"accessing the course content easily\", 92% reported \"easily navigating the curriculum\", 91% described the curriculum as \"well-organized\", and 87% reported that the lectures \"supported their learning\". Online delivery of a comprehensive GME orientation curriculum is useful and facilitates learner education, training, and integration into a large GME institution in the COVID-19 era.

Abdominal aortic aneurysm (AAA) is a deadly but often clinically silent disease. Patients at increased risk are elderly men with risk factors for vascular disease who may not have adequate screening through primary care. We sought to examine the prevalence and feasibility of screening for AAA in at-risk patients presenting for unrelated complaints using emergency physician–performed bedside ultrasound. At-risk patients presenting with unrelated complaints were screened for AAA by emergency physician–performed ultrasound. Scan was rated as complete, limited, or inadequate, and time to complete scan noted. Patients with identified AAA were provided with appropriate follow-up and were followed to look at confirmatory imaging and clinical course. A total of 179 patients were screened, with 12 AAAs discovered (6.7%; 95% confidence interval, 3.9%-11.4%). Average time to perform the screening ultrasound was 141 ± 135 seconds. Average discrepancy between emergency ultrasound and formal imaging was 3.9 mm. Of 12 (92%) patients, 11 were followed up, with repair recommended in 3 patients. The emergency department represents a potential opportunity for screening at-risk patients for AAA. Emergency ultrasound is a fast and accurate method for identifying patients with AAA who may benefit from follow-up or intervention.

Virtual interviews play a crucial role in the ranking process. National Resident Matching Program (NRMP) data shows a median number of 23.5 interviews per applicant. Considering this volume of interviews, graduate medical education programs must leverage the virtual pre-interview materials to impact applicants' attitudes and perceptions of the interview beforehand. This study is a secondary data analysis of an anonymous cross-sectional survey collected during two orientation sessions held in June and July 2022. Responses from 123 residents and fellows rated the usefulness of available print and virtual pre-interview resources. Using a 5-point Likert scale, social media sites scored an average usefulness score of 4.0, while the information packet and program website scored 3.88 and 3.90, respectively. This article provides recommendations for restructuring virtual resources to aid residents and fellows, specifically under-represented minorities in medicine (UiM) applicants, in having a quality interview experience.

Background Healthcare professional (HCP) burnout transcends clinician job title and role, thus creating a need for interprofessional strategies to address burnout. The organizational framework of offering employer-sponsored mindfulness programming to HCPs sets the stage for an orchestrated, mindful response to COVID-19. Objective This single arm pre-post interventional research tested changes in measures of burnout, resilience, perceived stress and work engagement for interprofessional HCP faculty and students participating in Mindfulness in Motion (MIM), a novel eight-week multimodal evidenced–based onsite intervention. Methods A Graduate Medical Education (GME) pilot of MIM was expanded to target inter-professional resiliency within an academic health center. MIM is the core offering of the Gabbe Health and Wellness program for students, staff, faculty, and residents and is embedded across the entire medical center. Results The faculty/student role demographic categories (n = 267) included resident physicians, resident chaplains, attending physicians, medical center faculty, and hospital administrative/managerial clinical staff. These cohorts demonstrated significant 27% reduction in participants meeting burnout criteria. Total burnout was determined by scores on subscales of emotional exhaustion (EE), depersonalization (DP), and personal accomplishment (PA) of the Maslach Burnout Inventory (MBI). There was a highly significant pre/post decrease in the in the emotional exhaustion (p < 0.00001) and depersonalization scores (p < 0.001), with highly significant increase in the personal accomplishment (p < 0.00001) scores. Resilience, as measured by the Connor Davidson Resiliency Scale (CDRS), significantly increased (p < 0.00001), alongside a significant increase (p < 0.00001) in the total Utrecht Work Engagement Score (UWES) and a significant decrease in scores on the Perceived Stress Scale (PSS) (p < 0.00001). Conclusion MIM significantly reduced burnout and perceived stress, for interprofessional (HCP) faculty and staff, while increasing resilience and work engagement in a large healthcare system. These results paved the way for an organizational response that utilized mindfulness to empower HCPs to navigate through the novel challenges presented by COVID-19.

Organizational mission statements gained popularity in the 1980s and have since become ubiquitous in both public and private organizations. Much of the extant research on mission statements has been in the corporate and nonprofit contexts, leaving a gap in the public context. In particular, scholarly inquiry into police mission statements is scant. This study fills this gap by building a broad-scale database on contemporary police department mission statements, thereby creating baseline data for exploratory research. Content analysis of 110 police mission statements reveals ten distinct themes recurring across the sample. A customer-focused composite score is constructed to measure the extent to which each mission statement is written from a customer-oriented perspective. Leveraging propositions from Goal-Setting Theory (GST) and David et al.’s (2014) customer-focused Mission Statement Theory (MST), this study examines whether a link exists between the ten themes, the customer-focused composite score, and the desired measurable outcomes. Community and police satisfaction survey data, FBI UCR data, a safety index, and a quality-of-life index are used to measure outcome variables. Relative to the customer-focused composite score, findings from the bivariate and multivariate analyses show a positive association between the composite score and overall community satisfaction in the police, indicating support for both GST and MST. As goal specificity, in the form of the customer-focused composite score, increases so does the measure of expressed satisfaction in the police department. These findings suggest mission statements may be a useful tool for bolstering measured outcomes when they have a high composite score (i.e., include many customer-focused themes). Police executives might consider examining their mission statements for the presence of these key themes and whether they are linked to specific positive outcomes for the community. Results from other statistical models are mixed. Three themes are associated with intended outcomes in the expected manner, thereby supporting the corresponding hypotheses. Six themes are related to their outcomes in a manner counter to expectations. For example, crime rates are higher, on average, in those jurisdictions where the police express the goal of reducing crime in their mission statement. This study lays the groundwork for future studies on police mission statements and provides guidance for police executives as they consider the themes communicated in their department’s mission statement and how they are connected to their measured outcomes.

Community coalitions are prime vehicles for fostering social support within communities and prominent mechanisms for building local capacities to address health and social concerns. However, sustaining these entities beyond initial efforts and funding is difficult. What has kept members participating in and committed to the work of the Clarkston (Georgia) Health Collaborative, a community coalition, nearly 15 years after its inception? Prior research has examined several variables that predict overall participation and commitment in community-based coalitions, however, the literature has largely focused on coalitions that are topic driven (e.g., diabetes, gang violence, drugs, or obesity). These studies fail to identify those factors that are important in sustaining efforts in non-topic-based (i.e., there is no singular focus, but topics are community generated and vary), non-grant-funded community coalitions. This cross-sectional study examines member engagement as a sustaining factor of coalitions. Members of the Clarkston Health Collaborative (N = 93), ages 21 to 70 years and representing various sectors of the community, as well as racial and ethnic backgrounds, were surveyed as part of a coalition assessment in 2007 and 2008 in Clarkston, Georgia. Predictors that influence their participation and commitment, key components of engagement, are analyzed. These components were: leadership, social resources, sense of community, empowerment, member satisfaction, communication, decision making, and participation benefits. Based on the review of the literature, specific mediating relationships are hypothesized. A mixed-methods approach is employed, including path analysis that tests how well process models fit the coalition data, as well as key informant interviews by coalition members. Toward a conceptual model of engagement, findings supported the hypothesis that effective leadership increases member participation through increased social resources. Findings also supported the hypotheses that shared decision making and effective leadership increases member commitment through increased member satisfaction. Clear communication and sense of community were also factors that contributed to increased participation and commitment. These findings have implications for intervention, policy, and research, including a need for interventions that recognize the contexts of influence that foster member engagement in community-based coalitions. In addition, insight is gained for the planning and implementation of other coalitions to help ensure coalition sustainability. Index words. Coalition, Community, Sustainability, Leadership, Social Resources, Sense of Community, Empowerment, Member Satisfaction, Communication, Decision Making, Participation Benefits

The dissertation examines the role of representations of the U.S. kitchen in debates about female citizenship, demonstrating that the kitchen is a terrain on which boundary disputes are waged over core American values: freedom and discipline; pleasure and labor; the organic and the technological; nostalgia for the past and fantasies of the future; and “proper” and “improper” femininities and families. During the postwar period, cultural representations and practices in government, corporate, and educational institutions constructed the kitchen as the nexus at which democracy, capitalism, and technological progress became indistinguishable from one another. Centering women as symbols and beneficiaries of that fusion, this construction also consolidated a vision of the normative American family that was to become the object of nostalgia into and beyond the conservative revolution of the 1980s. But this image of the kitchen was challenged and reworked, both by the white women who were its explicit objects and by the voices it excluded. In the 1950s Asian American authors used images of the kitchen to theorize the relationship between ethnicity and citizenship, while at the same time, the representations of Asian food in women's magazines stressed an ethical imperative for white, middle-class American women to educate their children as antiracist and cosmopolitan citizens appropriate to the Cold War U.S. role as defender of global democracy and capitalism. Yet by the 1980s, a new but disturbingly familiar national image of domesticity emerged, one that pitted (implicitly white) female subjectivity against racial and ethnic difference.

Holliday discusses the National Fire Academy's Command Sequence Cycle. The command sequence cycle is comprised of three elements: size-up, strategy and tactics, and implementation. These elements are more commonly referred to as \"think, plan, and act.\" Using this command cycle enables the incident commanders (ICs) to identify problems, come up with a plan to control them, initiate procedures to carry out the plan, and then repeat the entire sequence to reevaluate the operation and ascertain if it is having the desired impact. This command sequence should be used at all incidents and as an all-hazards approach to successfully manage an incident.