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Objective Mental health treatment is often initiated in primary care settings, but many primary care providers (PCPs), residents, and medical students report discomfort in managing psychiatric conditions. This study evaluated the effect of an educational workshop that featured an evidence-based psychopharmacology clinical decision support tool (CDST) on trainee confidence and willingness to treat psychiatric conditions. Methods Participants completed pre- and post-workshop surveys. Nine months after the workshop, a subset of trainees participated in a focus group. Results Of the participants, 62.5% of the obstetrics-gynecology (OB-GYN) resident physicians (10/16) and 100% of the medical students (18/18) completed both pre- and post-surveys. Following the workshop, OB-GYN resident physicians reported significantly improved confidence in treating psychiatric disorders ( p  < 0.001), sense of having psychiatric support tools ( p  < 0.001), and knowledge of treating psychiatric disorders ( p  = 0.021). Medical students reported significantly improved confidence in treating psychiatric disorders ( p  < 0.001), willingness to devise treatment plans for psychiatric disorders ( p  = 0.024), sense of having psychiatric support tools ( p  < 0.001), knowledge of treating psychiatric disorders ( p  < 0.001), and comfort in presenting a psychiatric treatment plan to an attending ( p  = 0.003). Most focus group participants (93.75%; 15/16) reported that they continued to use the CDST, and it increased their confidence in formulating psychiatric treatment plans. Conclusions These findings suggest that educational workshops that introduce high-quality psychopharmacology CDSTs may be an effective method for improving provider comfort in treating psychiatric disorders.

Interprofessional healthcare team function is critical to the effective delivery of patient care. Team members must possess teamwork competencies, as team function impacts patient, staff, team, and healthcare organizational outcomes. There is evidence that team training is beneficial; however, consensus on the optimal training content, methods, and evaluation is lacking. This manuscript will focus on training content. Team science and training research indicates that an effective team training program must be founded upon teamwork competencies. The Team FIRST framework asserts there are 10 teamwork competencies essential for healthcare providers: recognizing criticality of teamwork, creating a psychologically safe environment, structured communication, closed-loop communication, asking clarifying questions, sharing unique information, optimizing team mental models, mutual trust, mutual performance monitoring, and reflection/debriefing. The Team FIRST framework was conceptualized to instill these evidence-based teamwork competencies in healthcare professionals to improve interprofessional collaboration. This framework is founded in validated team science research and serves future efforts to develop and pilot educational strategies that educate healthcare workers on these competencies.

Interprofessional teamwork is vital to effective patient care, and targeting healthcare learners earlier in their education can lead to greater improvement in confidence and competence in teamwork skills. Despite this, institutions have continued struggling to integrate competency-based interprofessional teamwork curriculum in undergraduate health care professions’ education. The current article provides guidance related to design, implementation, and assessment for institutions seeking to implement competency-based teamwork education and training strategies for healthcare students. Guiding principles and strategies for curricular design focus on conducting thorough interprofessional needs analyses and building transportable, evidence-based competencies that apply across professions. For implementation, key principles center on strategies to ensure adequate professional representation and faculty development. Assessment considerations focus on building infrastructure for evaluation that spans professional schools. These strategies aim to create a robust, effective, and sustainable IPE curriculum that enhances collaboration and teamwork among future healthcare professionals. By addressing the key areas of design, implementation, and assessment, this article offers comprehensive guidelines for advancing interprofessional education. We believe incorporating the key guiding principles and strategies from this paper will enable institutions to integrate teamwork education and training more effectively into undergraduate healthcare training, which will facilitate institutions’ ability to ensure learners are “team ready” as they transition into the workforce after graduation.

Background As part of the worldwide call to enhance the safety of patient handovers of care, the Association of American Medical Colleges (AAMC) requires that all graduating students “give or receive a patient handover to transition care responsibly” as one of its Core Entrustable Professional Activities (EPAs) for Entering Residency. Students therefore require educational activities that build the necessary teamwork skills to perform structured handovers. To date, a reliable instrument designed to assess teamwork competencies, like structured communication, throughout their preclinical and clinical years does not exist. Method Our team developed an assessment instrument that evaluates both the use of structured communication and two additional teamwork competencies necessary to perform safe patient handovers. This instrument was utilized to assess 192 handovers that were recorded from a sample of 229 preclinical medical students and 25 health professions students who participated in a virtual course on safe patient handovers. Five raters were trained on utilization of the assessment instrument, and consensus was established. Each handover was reviewed independently by two separate raters. Results The raters achieved 72.22 % agreement across items in the reviewed handovers. Krippendorff’s alpha coefficient to assess inter-rater reliability was 0.6245, indicating substantial agreement among the raters. A confirmatory factor analysis (CFA) demonstrated the orthogonal characteristics of items in this instrument with rotated item loadings onto three distinct factors providing preliminary evidence of construct validity. Conclusions We present an assessment instrument with substantial reliability and preliminary evidence of construct validity designed to evaluate both use of structured handover format as well as two team competencies necessary for safe patient handovers. Our assessment instrument can be used by educators to evaluate learners’ handoff performance as early as their preclinical years and is broadly applicable in the clinical context in which it is utilized. In the journey to optimize safe patient care through improved teamwork during handovers, our instrument achieves a critical step in the process of developing a validated assessment instrument to evaluate learners as they seek to accomplish this goal.

\"Introduction to Teamwork\" (ITT) is the first module in the longitudinal curriculum of Team FIRST, an institutionally sponsored quality enhancement plan dedicated to expanding and improving teamwork competencies for health professions and medical students at UT Southwestern. ITT includes multiple interprofessional activities which occurs yearly at a face-to-face gathering. However, due to the limitations caused by COVID-19, this large-scale event was moved to a virtual platform. Although some of the activities were easily adapted to the virtual format, others had to be redesigned completely. Implementing these changes in the three months leading up to the event posed significant challenges. This study aimed to compare students' feedback in two consecutive years of ITT using Qualitative Data Analysis (QDA). A focus group study was completed to collect student feedback on ITT 2019. For ITT 2020, students' feedback was collected using a digital survey. According to the QDA, nine themes were identified including: preparation, organization, technology, instruction, facilitators, time, format, learning content, and team dynamics. While seven of these themes were common in both years, technology and format only appeared in ITT 2020 with several comments related to the platform used (Zoom). The majority of the comments received for ITT 2019 pertained to preparation (36%), facilitators (21%), and learning content (20%). In ITT 2020, however, most comments were focused on learning content (26%), technology and facilitators (14% each), and time (12%). Results of this study can be utilized by other academic organizations planning to translate established learning modules to a virtual platform.

RSV and SARS-CoV-2 are prone to co-infection with other respiratory viruses. In this study, we use RSV/SARS-CoV-2 co-infection to evaluate changes to clinical disease and viral replication in vivo. To consider the severity of RSV infection, effect of sequential infection, and the impact of infection timing, mice were co-infected with varying doses and timing. Compared with a single infection of RSV or SARS-CoV-2, the co-infection of RSV/SARS-CoV-2 and the primary infection of RSV followed by SARS-CoV-2 results in protection from SARS-CoV-2-induced clinical disease and reduces SARS-CoV-2 replication. Co-infection also augmented RSV replication at early timepoints with only the low dose. Additionally, the sequential infection of RSV followed by SARS-CoV-2 led to improved RSV clearance regardless of viral load. However, SARS-CoV-2 infection followed by RSV results in enhanced SARS-CoV-2-induced disease while protecting from RSV-induced disease. SARS-CoV-2/RSV sequential infection also reduced RSV replication in the lung tissue, regardless of viral load. Collectively, these data suggest that RSV and SARS-CoV-2 co-infection may afford protection from or enhancement of disease based on variation in infection timing, viral infection order, and/or viral dose. In the pediatric population, understanding these infection dynamics will be critical to treat patients and mitigate disease outcomes.

About a decade ago positive predictions were made regarding the international growth of franchising. This study was undertaken to examine the actual growth and development of franchising globally during the 1990s. Using survey and archival data findings regarding the state of franchising in 40 countries are presented. Franchising has met or exceeded the growth expectations, generating an average of $3.7 billion in annual sales in the nations investigated. However, considerable regional differences in franchising activities do exist. The business sectors experiencing the most franchising growth are retail and restaurants. Franchising firms tend to export their business formats to neighboring countries or to countries with similar cultural characteristics. Operational concerns regarding legal and social issues across borders are also examined. Implications for practice and research are discussed.

Purpose - The purpose of this study is to employ the concepts of the general management of innovation to help explain the extraordinary inventiveness of the Shaker religious community.Design methodology approach - Utilizing historical accounts of Shaker philosophy and practice, the paper examines Shaker innovativeness through the lens of the general management of innovation in order to develop a historical interpretation of innovation within the Shaker community.Findings - It was demonstrated that Shaker society possessed a large number of the organizational characteristics, management practices, and values, which have subsequently been found to be positively related to innovative behaviors in modern institutions.Research limitations implications - Future research should examine in even greater depth specific values, structure, and practices of Shaker communities as well as focusing on key concepts in other fields such as product, operations, or R&D management to yield additional insights into the management of innovation within organizations.Practical implications - The paper discusses several managerial actions derived from an examination of Shaker practices related to the general management of innovation that are relevant for contemporary organizations.Originality value - This study uses the extant history of Shaker society to examine, illustrate, and help explain contemporary general management of innovation. This exposition should help inform organizations interested in improving their efforts at spurring successful innovation.

This paper offers an in-depth treatment of conversion franchising, where new franchisees are added to a franchised system by recruiting existing independent entrepreneurs or competitors' franchisees. The first part of the paper examines conversion franchising as a source of competitive advantage. This discussion leads to the articulation of four propositions. The second part of the paper looks at the empirical results of our study of 72 North American franchisors. Seventy-two percent of these firms use conversion franchising in their domestic markets, and 26 percent use conversions in international locales. The propositions relating to a franchisor's decision to use conversions based on increased levels of experience, economic resources, and to a lesser extent skills/knowledge, all were supported. These results lend support to the literature indicating that resources and skills serve as sources of competitive advantage. Implications for research and practice are discussed.

The worldwide growth of franchising has been phenomenal during the past decade. At the same time there has been increased media attention to questionable business practices in franchising. Similar to some trade associations and professions, franchising has sought self-regulation by developing codes of conduct or ethics. This study examines the codes of ethics covering franchising activities in 21 countries. The results reveal that there is considerable variation in the activities/issues covered by the codes. Specifically, the codes cover most stages of the franchising relationship, focus on a narrow set of stakeholders, are short on ethical guidance, and offer few enforcement provisions. The implications of these findings for international franchising and research are discussed.