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Cullen MJ, Hane J, Zhou Y, Seltzer B, Sackett PR, Culican SM, Thakker K, Young JQ, Mustapha T. Perceptions of Justice in Clinical Learning Environments: Development and Validation of an Organizational Justice Measure for Medical Trainees. Acad Med 2024:00001888-990000000-00769. [PMID: 38412473 DOI: 10.1097/acm.0000000000005669] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Subscribe] [Scholar Register] [Indexed: 02/29/2024]
Abstract
PURPOSE This study aimed to develop an instrument to measure medical trainees' perceptions of justice in clinical learning environments. METHOD Between 2019 and 2023, the authors conducted a multiyear, multi-institutional, multiphase study to develop a 16-item justice measure with 4 dimensions: interpersonal, informational, procedural, and distributive. The authors gathered validity evidence based on test content, internal structure, and relationships with other variables across 3 phases. Phase 1 involved drafting items and gathering evidence that items measured intended dimensions. Phase 2 involved analyzing relevance of items for target groups, examining interitem correlations and factor loadings in a preliminary analysis, and obtaining reliability estimates. Phase 3 involved a confirmatory factor analysis and collecting convergent and discriminant validity evidence. RESULTS In phase 1, 63 of 91 draft items were retained following a content validation exercise gauging how well items measured targeted dimensions (mean [SD] item ratings within dimensions, 4.16 [0.36] to 4.39 [0.34]) on a 5-point Likert scale (with 1 indicating not at all well and 5 indicating extremely well). In phase 2, 30 items were removed due to low factor loadings (i.e., < 0.40), and 4 items per dimension were selected (factor loadings, 0.42-0.89). In phase 3, a confirmatory factor analysis supported the 4-dimension model (χ2 = 610.14, P < .001; comparative fit index = 0.90, Tucker-Lewis Index = 0.87, root mean squared error of approximation = 0.11, standardized root mean squared residual = 0.06), with convergent and discriminant validity evidence showing hypothesized positive correlations with a justice measure (r = 0.93, P < .001), trait positive affect (r = 0.46, P < .001), and emotional stability (r = 0.33, P < .001) and negative correlations with trait negative affect (r = -0.39, P < .001). CONCLUSIONS Results indicate the measure's potential utility in understanding justice perceptions and designing targeted interventions.
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Affiliation(s)
- Michael J Cullen
- M.J. Cullen is senior director of assessment, evaluation, and research for graduate medical education, University of Minnesota Medical School, Minneapolis, Minnesota; ORCID: https://orcid.org/0000-0002-4755-4276
| | | | - You Zhou
- J. Hane is assistant professor, Departments of Internal Medicine and Pediatrics, University of Minnesota Medical School, Minneapolis, Minnesota; ORCID: https://orcid.org/0000-0002-1957-6128
| | - Ben Seltzer
- Y. Zhou is a graduate student, Industrial/Organizational Psychology Program, University of Minnesota-Twin Cities, Minneapolis, Minnesota; ORCID: https://orcid.org/0000-0003-1142-5445
| | - Paul R Sackett
- B. Seltzer is a research and data analyst, University of Minnesota Medical School, Minneapolis, Minnesota; ORCID: https://orcid.org/0009-0007-1441-7762
| | - Susan M Culican
- P.R. Sackett is professor of psychology, Industrial/Organizational Psychology Program, University of Minnesota-Twin Cities, Minneapolis, Minnesota; ORCID: https://orcid.org/0000-0001-7633-4160
| | - Krima Thakker
- S.M. Culican is professor, Department of Ophthalmology and Visual Neurosciences, and associate dean for graduate medical education, University of Minnesota Medical School, Minneapolis, Minnesota; ORCID: https://orcid.org/0000-0002-4310
| | - John Q Young
- K. Thakker is research coordinator, Zucker Hillside Hospital, Northwell Health, Glen Oaks, New York; ORCID: https://orcid.org/0000-0002-1737-2113
| | - Taj Mustapha
- K. Thakker is research coordinator, Zucker Hillside Hospital, Northwell Health, Glen Oaks, New York; ORCID: https://orcid.org/0000-0002-1737-2113
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Cullen MJ, Zhang C, Sackett PR, Thakker K, Young JQ. Can a Situational Judgment Test Identify Trainees at Risk of Professionalism Issues? A Multi-Institutional, Prospective Cohort Study. Acad Med 2022; 97:1494-1503. [PMID: 35612909 DOI: 10.1097/acm.0000000000004756] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/15/2023]
Abstract
PURPOSE To determine whether overall situational judgment test (SJT) scores are associated with programs' clinical competency committee (CCC) ratings of trainee professionalism, any concerning behavior, and concerning behavior requiring active remediation at 2 time periods. METHOD In fall 2019, trainees from 17 U.S. programs (16 residency, 1 fellowship) took an online 15-scenario SJT developed to measure 7 dimensions of professionalism. CCC midyear and year-end (6 months and 1 year following SJT completion, respectively) professionalism scores and concern ratings were gathered for academic year 2019-2020. Analyses were conducted to determine whether overall SJT scores related to overall professionalism ratings, trainees displaying any concerns, and trainees requiring active remediation at both time periods. RESULTS Overall SJT scores correlated positively with midyear and year-end overall professionalism ratings ( r = .21 and .14, P < .001 and = .03, respectively). Holding gender and race/ethnicity constant, a 1 standard deviation (SD) increase in overall SJT score was associated with a .20 SD increase in overall professionalism ratings at midyear ( P = .005) and a .22 SD increase at year-end ( P = .001). Holding gender and race/ethnicity constant, a 1 SD increase in overall SJT score decreased the odds of a trainee displaying any concerns by 37% (odds ratio [OR] 95% confidence interval [CI]: [.44, .87], P = .006) at midyear and 34% (OR 95% CI: [.46, .95], P = .025) at year-end and decreased the odds of a trainee requiring active remediation by 51% (OR 95% CI: [.25, .90], P = .02) at midyear. CONCLUSIONS Overall SJT scores correlated positively with midyear and year-end overall professionalism ratings and were associated with whether trainees exhibited any concerning behavior at midyear and year-end and whether trainees needed active remediation at midyear. Future research should investigate whether other potential professionalism measures are associated with concerning trainee behavior.
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Affiliation(s)
- Michael J Cullen
- M.J. Cullen is senior director of assessment, evaluation, and research for graduate medical education, University of Minnesota Medical School, Minneapolis, Minnesota; ORCID: https://orcid.org/0000-0002-4755-4276
| | - Charlene Zhang
- C. Zhang was a graduate student, Industrial/Organizational Psychology Program, University of Minnesota-Twin Cities, Minneapolis, Minnesota, at the time of the study. The author is now a research scientist, Amazon, Alexandria, Virginia; ORCID: http://orcid.org/0000-0001-6975-5653
| | - Paul R Sackett
- P.R. Sackett is professor of psychology, Industrial/Organizational Psychology Program, University of Minnesota-Twin Cities, Minneapolis, Minnesota; ORCID: http://orcid.org/0000-0001-7633-4160
| | - Krima Thakker
- K. Thakker is research coordinator, Zucker Hillside Hospital, Northwell Health, Glen Oaks, New York; ORCID: https://orcid.org/0000-0002-1737-2113
| | - John Q Young
- J.Q. Young is professor and chair, Department of Psychiatry, Donald and Barbara Zucker School of Medicine at Hofstra/Northwell, Hempstead, New York, and senior vice president, behavioral health, Northwell Health, Lake Success, New York; ORCID: https://orcid.org/0000-0003-2219-5657
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Young JQ, Friedman KA, Thakker K, Hennus MP, Hennessy M, Patterson A, Yacht A, ten Cate O. Supervision and Care Quality as Perceived by Redeployed Attendings, Fellows, and Residents During a COVID-19 Surge: Lessons for the Future. Acad Med 2022; 97:S28-S34. [PMID: 34789660 PMCID: PMC8855770 DOI: 10.1097/acm.0000000000004529] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/13/2023]
Abstract
PURPOSE To better prepare for potential future large-scale redeployments, this study examines quality of supervision and care as perceived by redeployed residents, fellows, and attendings during a COVID-19 surge. METHOD During April and May 2020, attendings, fellows, and residents redeployed at 2 teaching hospitals were invited to participate in a survey, which included questions on respondents' prior experience; redeployed role; amount of supervision needed and received; and perceptions of quality of supervision, patient care, and interprofessional collaboration. Frequencies, means, and P values were calculated to compare perceptions by experience and trainee status. Narrative responses to 2 open-ended questions were independently coded; themes were constructed. RESULTS Overall, 152 of 297 (51.2%) individuals responded, including 64 of 142 attendings (45.1%), 40 of 79 fellows (50.6%), and 48 of 76 residents (63.2%). Fellows and attendings, regardless of prior experience, perceived supervision as adequate. In contrast, experienced residents reported receiving more supervision than needed, while inexperienced residents reported receiving less supervision than needed and rated overall supervision as poor. Attendings, fellows, and experienced residents rated the overall quality of care as acceptable to good, whereas inexperienced residents perceived overall quality of care as worse to much worse, particularly when compared with baseline. CONCLUSIONS Narrative themes indicated that the quality of supervision and care was buffered by strong camaraderie, a culture of informal consultation, team composition (mixing experienced with inexperienced), and clinical decision aids. The markedly negative view of inexperienced residents suggests a higher risk for disillusionment, perhaps even moral injury, during future redeployments. Implications for planning are explored.
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Affiliation(s)
- John Q. Young
- J.Q. Young is professor, Department of Psychiatry, Donald and Barbara Zucker School of Medicine at Hofstra/Northwell, Hempstead, New York; ORCID: https://orcid.org/0000-0003-2219-5657
| | - Karen A. Friedman
- K.A. Friedman is professor, Department of Medicine, Donald and Barbara Zucker School of Medicine at Hofstra/Northwell, Hempstead, New York; ORCID: https://orcid.org/0000-0003-1980-1839
| | - Krima Thakker
- K. Thakker is research associate, Zucker Hillside Hospital at Northwell Health, Glen Oaks, New York
| | - Marije P. Hennus
- M.P. Hennus is professor, University Medical Center Utrecht, Utrecht, The Netherlands; ORCID: https://orcid.org/0000-0003-1508-0456
| | - Martina Hennessy
- M. Hennessy is associate professor, Trinity College Dublin School of Medicine, Dublin, Ireland; ORCID: https://orcid.org/0000-0002-2153-5288
| | - Aileen Patterson
- A. Patterson is assistant professor, Trinity College Dublin School of Medicine, Dublin, Ireland; ORCID: https://orcid.org/0000-0003-4315-0917
| | - Andrew Yacht
- A. Yacht is professor, Department of Medicine, Donald and Barbara Zucker School of Medicine at Hofstra/Northwell, Hempstead, New York
| | - Olle ten Cate
- O. ten Cate is a professor, University Medical Center Utrecht, Utrecht, The Netherlands; ORCID: https://orcid.org/0000-0002-6379-8780
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Bhuiya T, Thakker K, Hyacinthe J, Cioe-Pena E. Community Needs Assessment of Low-Income Sections of 10 Rural Villages in Karnataka and Tamil Nadu, India. Cureus 2022; 14:e21271. [PMID: 35178325 PMCID: PMC8842870 DOI: 10.7759/cureus.21271] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/15/2022] [Indexed: 11/05/2022] Open
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Young JQ, Thakker K, John M, Friedman K, Sugarman R, van Merriënboer JJG, Sewell JL, O'Sullivan PS. Exploring the relationship between emotion and cognitive load types during patient handovers. Adv Health Sci Educ Theory Pract 2021; 26:1463-1489. [PMID: 34037906 DOI: 10.1007/s10459-021-10053-y] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/01/2020] [Accepted: 05/05/2021] [Indexed: 06/12/2023]
Abstract
Cognitive Load Theory has emerged as an important approach to improving instruction in the health professions workplace, including patient handovers. At the same time, there is growing recognition that emotion influences learning through numerous cognitive processes including motivation, attention, working memory, and long-term memory. This study explores how emotion influences the cognitive load experienced by trainees performing patient handovers. From January to March 2019, 693 (38.7%) of 1807 residents and fellows from a 24-hospital health system in New York city completed a survey after performing a handover. Participants rated their emotional state and cognitive load. The survey included questions about features of the learner, task, and instructional environment. The authors used factor analysis to identify the core dimensions of emotion. Regression analyses explored the relationship between the emotion factors and cognitive load types. Two emotion dimensions were identified representing invigoration and tranquility. In regression analyses, higher levels of invigoration, tranquility, and their interaction were independently associated with lower intrinsic load and extraneous load. The interaction of invigoration and tranquility predicted lower germane load. The addition of the emotion variables to multivariate models including other predictors of cognitive load types significantly increased the amount of variance explained. The study provides a model for measuring emotions in workplace learning. Because emotion appears to have a significant influence on cognitive load types, instructional designers should consider strategies that help trainees regulate emotion in order to reduce cognitive load and improve learning and performance.
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Affiliation(s)
- John Q Young
- Department of Psychiatry, Donald and Barbara Zucker School of Medicine at Hofstra/Northwell, Hempstead, NY, USA.
| | - Krima Thakker
- Division of Education and Training, Zucker Hillside Hospital at Northwell Health, 75-59 263rd Street, Glen Oaks, NY, 10543, USA
| | - Majnu John
- Division of Research, Zucker Hillside Hospital at Northwell Health, Glen Oaks, NY, USA
| | - Karen Friedman
- Department of Medicine, Donald and Barbara Zucker School of Medicine at Hofstra/Northwel, Hempstead, NY, USA
| | | | - Jeroen J G van Merriënboer
- School of Health Professions Education, Faculty of Health, Medicine, and Life Sciences, Maastricht University, Maastricht, the Netherlands
| | - Justin L Sewell
- Department of Medicine, University of California at San Francisco School of Medicine, San Francisco, CA, USA
| | - Patricia S O'Sullivan
- Department of Medicine & Office of Research and Development in Medical Education, University of California at San Francisco School of Medicine, San Francisco, CA, USA
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Young JQ, Friedman KA, Sewell JL, Thakker K, John M, van Merrienboer JJG, O'Sullivan PS. Influence of Emotion on Cognitive Load Experienced by Trainees While Performing Patient Handoffs. Acad Med 2021; 96:S221-S222. [PMID: 34705724 DOI: 10.1097/acm.0000000000004330] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/13/2023]
Affiliation(s)
- John Q Young
- Author affiliations: J.Q. Young, K.A. Friedman, Donald and Barbara Zucker School of Medicine at Hofstra/Northwell
| | - Karen A Friedman
- Author affiliations: J.Q. Young, K.A. Friedman, Donald and Barbara Zucker School of Medicine at Hofstra/Northwell
| | - Justin L Sewell
- J.L. Sewell, P.S. O'Sullivan, University of California, San Francisco
| | - Krima Thakker
- K. Thakker, M. John, Zucker Hillside Hospital at Northwell Health
| | - Maju John
- K. Thakker, M. John, Zucker Hillside Hospital at Northwell Health
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Young JQ, Thakker K, John M, Friedman K, Sugarman R, Sewell JL, O'Sullivan PS. Features of the learner, task, and instructional environment that predict cognitive load types during patient handoffs: Implications for instruction. Appl Cognit Psychol 2021. [DOI: 10.1002/acp.3803] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Affiliation(s)
- John Q. Young
- Department of Psychiatry Donald and Barbara Zucker School of Medicine at Hofstra/Northwell Hempstead New York USA
- Department of Psychiatry Zucker Hillside Hospital at Northwell Health Glen Oaks New York USA
| | - Krima Thakker
- Department of Psychiatry Zucker Hillside Hospital at Northwell Health Glen Oaks New York USA
| | - Majnu John
- Division of Research Zucker Hillside Hospital at Northwell Health Glen Oaks New York USA
| | - Karen Friedman
- Department of Medicine Donald and Barbara Zucker School of Medicine at Hofstra/Northwell Hempstead New York USA
| | - Rebekah Sugarman
- School of Medicine University of Michigan Ann Arbor Michigan USA
| | - Justin L. Sewell
- Department of Medicine School of Medicine, University of California, San Francisco San Francisco California USA
| | - Patricia S. O'Sullivan
- Department of Medicine School of Medicine, University of California, San Francisco San Francisco California USA
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Young JQ, John M, Thakker K, Friedman K, Sugarman R, Sewell JL, O'Sullivan PS. Evidence for validity for the Cognitive Load Inventory for Handoffs. Med Educ 2021; 55:222-232. [PMID: 32668076 DOI: 10.1111/medu.14292] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/28/2020] [Revised: 06/29/2020] [Accepted: 07/09/2020] [Indexed: 06/11/2023]
Abstract
CONTEXT Patient handovers remain a significant patient safety challenge. Cognitive load theory (CLT) can be used to identify the cognitive mechanisms for handover errors. The ability to measure cognitive load types during handovers could drive the development of more effective curricula and protocols. No such measure currently exists. METHODS The authors developed the Cognitive Load Inventory for Handoffs (CLIH) using a multi-step process, including expert interviews to enhance content validity and talk-alouds to optimise response process validity. The final version contained 28 items. From January to March 2019, we administered a cross-sectional survey to 1807 residents and fellows from a large health care system in the USA. Participants completed the CLIH following a handover. Exploratory factor analysis of data from one-third of respondents identified high-performing items; confirmatory factor analysis of data from the remaining sample assessed model fit. Model fit was evaluated using the comparative fit index (CFI) (>0.90), Tucker-Lewis index (TFI) (>0.80), standardised root mean square residual (SRMR) (<0.08) and root mean square of error of approximation (RMSEA) (<0.08). RESULTS Participants included 693 trainees (38.4%) (231 in the exploratory study and 462 in the confirmatory study). Eleven items were removed during exploratory factor analysis. Confirmatory factor analysis of the 16 remaining items (five for intrinsic load, seven for extraneous load and four for germane load) supported a three-factor model and met criteria for good model fit: the CFI was 0.95, TFI was 0.93, RMSEA was 0.074 and SRMR was 0.07. The factor structure was comparable for gender and role. Intrinsic, extraneous and germane load scales had high internal consistency. With one exception, scale scores were associated, as hypothesised, with postgraduate level and clinical setting. CONCLUSIONS The CLIH measures three types of cognitive load during patient handovers. Evidencefor validity is provided for the CLIH's content, response process, internal structure and association with other variables. This instrument can be used to determine the relative drivers of cognitive load during handovers in order to optimize handover instruction and protocols.
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Affiliation(s)
- John Q Young
- Department of Psychiatry, Donald and Barbara Zucker School of Medicine at Hofstra/Northwell, Hempstead, New York, USA
- Department of Psychiatry, Zucker Hillside Hospital at Northwell Health, Glen Oaks, New York, USA
| | - Majnu John
- Division of Research, Zucker Hillside Hospital at Northwell Health, Glen Oaks, New York, USA
| | - Krima Thakker
- Division of Education and Training, Zucker Hillside Hospital at Northwell Health, Glen Oaks, New York, USA
| | - Karen Friedman
- Department of Medicine, Donald and Barbara Zucker School of Medicine at Hofstra/Northwell, Hempstead, New York, USA
| | - Rebekah Sugarman
- University of Michigan School of Medicine, Ann Arbor, Michigan, USA
| | - Justin L Sewell
- Department of Medicine, University of California, San Francisco School of Medicine, San Francisco, California, USA
| | - Patricia S O'Sullivan
- Department of Medicine, University of California, San Francisco School of Medicine, San Francisco, California, USA
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Young JQ, Sugarman R, Schwartz J, Thakker K, O'Sullivan PS. Exploring Residents' Experience of Career Development Scholarship Tracks: A Qualitative Case Study Using Social Cognitive Career Theory. Teach Learn Med 2020; 32:522-530. [PMID: 32394735 DOI: 10.1080/10401334.2020.1751637] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/11/2023]
Abstract
Problem: Trainees enter graduate medical education with professional aspirations that often extend beyond the role of clinician to roles such as educator, innovator, leader, advocate, or researcher. Many residency programs have implemented academic tracks to support career development in these areas. With the exception of research tracks, these tracks generally do not include significant longitudinal protected time and often rely upon 'extra-curricular' effort and possess insufficient structure, mentorship, and accountability. Most prior studies of non-research scholarship tracks have not been theory driven and do not explore in depth the experience of residents who participate. Approach: To address this gap in the literature, we conducted a qualitative case study informed by Social Cognitive Career Theory to explore the professional identity development of residents who participated in a non-research scholarship track that incorporates recommended best practices. The track, Pathways to Expertise Program, incorporates features of successful research tracks: protected time, longitudinal experience, mentorship, platforms for recognition, and accountability. Participants from the first three cohorts were interviewed at the time of their graduation (2017-2019). Semi-structured interviews were conducted, transcribed, and independently coded. Social Cognitive Career Theory informed the organization of codes into themes. Context: The Pathways to Expertise Program was implemented in a psychiatry residency training program in a large urban academic teaching hospital. Impact: Fifteen residents entered Pathways to Expertise Program during the study period and all 15 participated in the study. Fourteen completed the program and presented their projects at the department grand rounds. For dissemination, 12 presented their project findings at one or more national meetings in the form of a poster (20 distributed across 11 residents), workshop (six distributed across four residents), or presentation (two across two residents). Six residents accounted for a total of seven first author publications in peer reviewed journals. All participants described how their self-efficacy increased as a result of new skills (e.g., content, methodology, and scientific communication), mentorship (e.g., content and process guidance), peer and broader support (e.g., small group supervision), persuasive communications (e.g., recognition both locally and nationally), and positive emotional reactions (e.g., triumph). The residents also described expecting compelling benefits (e.g., stronger application for fellowship and expanded career opportunities). Participants indicated that the experience influenced their career goals and how they perceived their professional identities. Lessons Learned: These findings suggest that a longitudinal academic track that incorporates features of successful research tracks (protected time, mentorship, peer support, and accountability for deliverables) can be instrumental in forming and maturing professional identities for non-clinical roles. These tracks can accomplish several important goals, including enhancing resilience via identity formation around passion and purpose and meeting society's need for physicians who are engaged in inquiry and innovation. Implications for the design of academic tracks in general are explored.
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Affiliation(s)
- John Q Young
- Department of Psychiatry, Donald and Barbara Zucker School of Medicine, Glen Oaks, New York, USA
| | - Rebekah Sugarman
- Department of Psychiatry, Donald and Barbara Zucker School of Medicine, Glen Oaks, New York, USA
| | - Jessica Schwartz
- Department of Psychiatry, Donald and Barbara Zucker School of Medicine, Glen Oaks, New York, USA
| | - Krima Thakker
- Department of Psychiatry, Donald and Barbara Zucker School of Medicine, Glen Oaks, New York, USA
| | - Patricia S O'Sullivan
- Department of Medicine, University of California, San Francisco School of Medicine, San Francisco, California, USA
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Young JQ, Schwartz J, Thakker K, O'Sullivan PS, Sugarman R. Where Passion Meets Need: a Longitudinal, Self-Directed Program to Help Residents Discover Meaning and Develop as Scholars. Acad Psychiatry 2020; 44:455-460. [PMID: 32236895 DOI: 10.1007/s40596-020-01224-x] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/15/2019] [Accepted: 03/18/2020] [Indexed: 06/11/2023]
Affiliation(s)
- John Q Young
- Donald and Barbara Zucker School of Medicine at Hofstra/Northwell, Hempstead, NY, USA.
| | - Jessica Schwartz
- Donald and Barbara Zucker School of Medicine at Hofstra/Northwell, Hempstead, NY, USA
| | - Krima Thakker
- Donald and Barbara Zucker School of Medicine at Hofstra/Northwell, Hempstead, NY, USA
| | | | - Rebekah Sugarman
- Donald and Barbara Zucker School of Medicine at Hofstra/Northwell, Hempstead, NY, USA
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Stawicki S, Garg S, Garg M, Paladino L, Jeanmonod D, Jeanmonod R, McDonald M, Nanda S, Opara I, Miller A, Papadimos T, Peck G, Sifri Z, Swaroop M, Thakker K, Yaffe A, Galwankar S, Bloem C, Arquilla B, Anderson H. The Fourth Annual Academic International Medicine Congress (AIM 2019) in Philadelphia, Pennsylvania, July 26–28, 2019: Advancing Global Leadership to Promote Health Equity. Int J Acad Med 2019. [DOI: 10.4103/ijam.ijam_61_19] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
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Oury TD, Thakker K, Menache M, Chang LY, Crapo JD, Day BJ. Attenuation of bleomycin-induced pulmonary fibrosis by a catalytic antioxidant metalloporphyrin. Am J Respir Cell Mol Biol 2001; 25:164-9. [PMID: 11509325 DOI: 10.1165/ajrcmb.25.2.4235] [Citation(s) in RCA: 104] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022] Open
Abstract
Oxidative stress plays an important role in the development of fibrotic responses in the lung. However, it is not clear whether inhibiting oxidative stress with antioxidants can attenuate fibrotic processes in the lung. The objective of these studies was to test whether the catalytic antioxidant porphyrin manganese (III) tetrakis (4-benzoic acid) porphyrin (MnTBAP) could protect mice against bleomycin-induced lung fibrosis. A 10 mg/kg intraperitoneal dose of MnTBAP was established as safe and had a serum and lung half-life of 9.5 h in mice. Based on this data, four groups of mice were given one dose of bleomycin (3.2 U/kg, intratracheal) or saline and MnTBAP (5 mg/kg, intraperitoneal) or saline twice daily for 14 d. Lung fibrosis was assessed by measuring (1) lung hydroxyproline content as an index of collagen accumulation, (2) airway dysfunction by whole body plethysmography, and (3) histopathology. Bleomycin produced a 20% loss in body weight that was only 10% in the bleomycin/MnTBAP group. Bleomycin produced a twofold increase in hydroxyproline content that was decreased 23% by MnTBAP. Bleomycin produced a twofold increase in airway dysfunction that was also attenuated 30% by MnTBAP. Histopathologic analysis of the lungs of mice treated with bleomycin demonstrated a severe fibrotic response that was attenuated 28% by MnTBAP. Future studies on the oxidant mechanisms that MnTBAP is affecting in this bleomycin model of lung fibrosis may shed light on potential new therapeutic approaches for treating interstitial lung diseases.
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Affiliation(s)
- T D Oury
- Department of Pathology, University of Pittsburgh, Pittsburgh, Pennsylvania, USA
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Lill JS, O'Sullivan T, Bauer LA, Horn JR, Carithers R, Strandness DE, Lau H, Chan K, Thakker K. Pharmacokinetics of diclofenac sodium in chronic active hepatitis and alcoholic cirrhosis. J Clin Pharmacol 2000; 40:250-7. [PMID: 10709153 DOI: 10.1177/00912700022008919] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
The objective of this study was to assess the pharmacokinetics of diclofenac sodium and its five metabolites following administration of a 150 mg oral dose to healthy subjects and patients with either chronic active hepatitis of varying morphology or alcoholic cirrhosis. Six healthy subjects, 6 chronic active hepatitis patients, and 6 alcoholic cirrhosis patients were enrolled in this prospective, open-label, parallel study. Blood samples were drawn at 0, 0.25, 0.5, 0.75, 1, 2, 4, 6, 8, 12, 24, 48, 72, 144, 312, and 480 hours, and urine samples were collected for 144 hours after administration of a single oral dose of diclofenac sodium. The mean area under the serum concentration-time curve extrapolated to infinity, oral clearance, half-life, maximal concentration, and time to peak concentration for diclofenac and its metabolites were determined and compared using analysis of variance. Cirrhotics had a mean +/- SD diclofenac AUC value (19,114 +/- 6806 ng.h/ml) significantly different (p < 0.02) from hepatitis patients (6071 +/- 1867 ng.h/ml) and healthy subjects (7008 +/- 2006 ng.h/ml), whereas healthy subjects and hepatitis patients had similar values. Comparable results were found for 4'-hydroxydiclofenac. The AUC values for 3'-hydroxydiclofenac and 3'-hydroxy-4'methoxydiclofeanc were significantly different when healthy subjects were compared to cirrhotics. However, hepatitis subjects were not significantly different from either group. The results indicate that hepatitis does not alter the pharmacokinetics of diclofenac. Alcoholic cirrhosis increased the mean diclofenac AUC approximately three times compared to normal subjects, indicating that one-third of the usual dose in cirrhotics would produce equivalent AUC values in normal subjects and subjects with alcoholic cirrhosis. However, since pharmacodynamic measurements were not made and no increase in untoward or side effects was noted in the alcoholic cirrhosis patients after a single dose, maintenance doses should be titrated to patients response.
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Affiliation(s)
- J S Lill
- University of Washington, Department of Pharmacy, Seattle 98195-7630, USA
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14
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Amsden GW, Foulds G, Thakker K. Pharmacokinetic study of azithromycin with fluconazole and cotrimoxazole (trimethoprim-sulfamethoxazole) in healthy volunteers. Clin Drug Investig 2000; 20:135-42. [PMID: 23315355 DOI: 10.2165/00044011-200020020-00008] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/02/2022]
Abstract
BACKGROUND Azithromycin, fluconazole and cotrimoxazole (trimethoprim-sulfamethoxazole; TMP/SMX) are all agents that are utilised for the treatment and/or prophylaxis of opportunistic infections in patients with AIDS. OBJECTIVE To characterise the potential for an interaction when azithromycin is coadministered with cotrimoxazole or with fluconazole. DESIGN Two separate nonblind randomised studies were conducted in healthy volunteers. During the fluconazole study the potential for fluconazole to adversely affect the pharmacokinetics of azithromycin was also studied. PARTICIPANTS 24 (cotrimoxazole) and 18 (fluconazole) healthy male and female volunteers. RESULTS The results of both studies indicated that neither the peak concentrations of nor the exposures (area under the concentration-time curve) to the test drugs were changed when azithromycin was coadministered. In addition, fluconazole did not significantly alter the pharmacokinetic parameters of azithromycin. CONCLUSIONS Azithromycin does not alter the bioavailability of either cotrimoxazole or fluconazole.
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Affiliation(s)
- G W Amsden
- The Clinical Pharmacology Research Center, Research Institute and Departments of Pharmacy and Medicine, Bassett Healthcare, Cooperstown, New York, USA,
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15
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Abstract
SPC-100270 drug substance ((2S,3S)-2-aminooctadecane-1,3-diol) is a synthetic sphingosine analogue possessing limited ultraviolet absorbance (UV) and two chiral centres. Analytical methodology employing derivatization of SPC-100270 with o-phthaldialdehyde (OPA) and a chiral thiol, N-acetyl-D-penicillamine, was developed to assess the isomeric purity of SPC-100270 in the presence of two of its three stereoisomers. Separation of the isoindole derivatives was achieved with isocratic reversed-phase column chromatography with detection at 330 nm. Under the conditions studied, the derivatization was complete within 3 h at 50 degrees C. The standard and derivatized solutions were stable for 7 days under refrigerated conditions. The limit of detection was 0.036 micrograms SPC-100270 per ml and the limit of quantitation was 0.237 micrograms SPC-100270 per ml. The assay response was linear over a concentration range of 4.7-376 micrograms SPC-100270 per ml with a coefficient of determination of greater than 0.9999. The precision, ruggedness and specificity of the assay were acceptable for determination of SPC-100270 in the presence of its stereoisomers and under forced degradation conditions. The method has been applied successfully in two independent laboratories for quality control release and stability assessment of SPC-100270 drug substance for early clinical studies.
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Affiliation(s)
- R A Rajewski
- Oread Laboratories, Inc., Lawrence, KS 66047, USA
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Sale ME, Barbey JT, Woosley RL, Edwards D, Yeh J, Thakker K, Chung M. The electrocardiographic effects of cetirizine in normal subjects. Clin Pharmacol Ther 1994; 56:295-301. [PMID: 7924125 DOI: 10.1038/clpt.1994.140] [Citation(s) in RCA: 50] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/27/2023]
Abstract
OBJECTIVE To establish whether the antihistamine cetirizine has the potential to prolong the QTc interval in normal volunteers at up to six times the usual recommended dose. METHODS Twenty-five healthy volunteers were studied in a prospective, double-blind crossover design conducted on inpatients in a Clinical Research Center. The primary end point of the study was QTc prolongation on the surface electrocardiogram (ECG). Plasma concentrations of cetirizine were also measured for pharmacokinetic analysis. The end point for the pharmacokinetic analysis was the dose/area under the concentration-time curve (apparent clearance of an oral dose). The subjects received the following three treatments in random sequence: placebo, 20 mg/day cetirizine, and 60 mg/day cetirizine for 7 consecutive days. A series of baseline ECGs was recorded over 2 days before each treatment, while the subject receiving placebo. ECG effects of the treatments were then compared with the baseline ECGs. RESULTS Analysis of variance showed no difference between the treatment groups (placebo, 20 mg cetirizine, and 60 mg cetirizine every day) in effect on QTc compared with baseline. A paired Student t test showed no difference in dose/area under the concentration-time curve between the 20 mg/day and 60 mg/day dosing groups at steady state. CONCLUSION In healthy volunteers, cetirizine does not prolong the QTc interval at doses of up to six times the usual recommended dose.
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Affiliation(s)
- M E Sale
- Department of Medicine, Georgetown University, Washington, DC 20007
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