Vineet M. Arora

INTERNATIONAL REGISTERED REPORT RR2-10.21203/rs.3.rs-9601998/v1 UNSTRUCTURED This paper presents preliminary findings of the Dime La Verdad ("Tell Me the Truth") study, a stepped-wedge trial of an educational intervention designed to support “promotores de salud” (community health workers) in disseminating reliable, evidence-based information about respiratory virus prevention in Hispanic communities (e.g., COVID-19, influenza) using social media. Through pre-intervention surveys and focus groups, promotores shared strategies and challenges faced in countering misinformation. Promotores use digital platforms to counter misinformation despite persistent structural gaps, including lack of employer support and unclear organizational expectations. These structural barriers must be addressed to fully realize their potential as science communicators in Hispanic communities.

Background: Chronic obstructive pulmonary disease (COPD) affects approximately 16 million Americans and often results in avoidable readmissions due, in part, to medication errors and lack of education. Telehealth interventions can support medication reconciliation and inhaler education following hospital discharge for patients with COPD. Objective: This study aimed to design and prototype TELE-TOC (Telehealth Education: Leveraging Electronic Transitions of Care), a post-discharge, in-home, televisit intervention, and to map its workflow to ensure integration into the routine discharge care transition process for patients with COPD. Methods: A user-centered design approach across 3 phases was followed to develop and prototype TELE-TOC. Participants included adult patients hospitalized for COPD exacerbations, their caregivers, clinicians involved in COPD care, and organizational leaders. Data collection methods included semi-structured interviews, system usability scale surveys, and cognitive walkthroughs of the TELE-TOC prototype to assess participants’ perceptions on usability and feasibility of TELE-TOC implementation as part of routine COPD discharge care transitions. Qualitative data were analyzed using inductive thematic analysis and an inductive-deductive approach guided by the Agency for Healthcare Research and Quality–endorsed Care Transitions Framework. Quantitative data were summarized using basic descriptive statistics. Results: Participants included 18 patients, 18 clinicians, 8 organizational leaders, and 2 caregivers. Phase 1 identified 3 interdependent stages of COPD hospital-to-home discharge: inpatient pre-discharge, at-home post-discharge, and outpatient clinic visit post-discharge. Key facilitators of discharge care transitions included the hospital’s “meds-to-beds” program and high patient health literacy, while barriers to discharge included poor timing of education and conflicting patient priorities. Phase 2 delineated the core televisit components (eg, dedicated clinician, medication reconciliation, inhaler use, and self-management education) and flexible components (eg, reminder system and session frequency). Potential implementation enablers included multiple techniques for clinicians to access and support patient education and backup communication strategies in the event of technical issues. Potential implementation barriers included insufficient patient technology access and limited technology and health literacy, as well as limited clinician bandwidth for thorough COPD education and medication reconciliation. Phase 3 TELE-TOC prototype walkthroughs demonstrated a positive patient experience (average system usability scale score of 97.5/100), attributed to the benefits of videoconferencing technology for hands-on teaching and the use of the virtual teach-back method. Identified barriers included varying levels of patient technology literacy, insufficient inhaler education, limited patient understanding of medication lists, and clinician uncertainty around TELE-TOC documentation. Suggestions for mitigating these barriers included patient training for TELE-TOC sessions, amendments to pharmacists’ “visit note,” and enhanced patient preparation for medication reconciliation. Conclusions: Using a co-design approach, we integrated multiple perspectives to develop and optimize TELE-TOC, a patient-centered televisit intervention aimed at supporting discharge care transitions to improve continuity of care and outcomes for patients with COPD. Future research will evaluate the impact of TELE-TOC on readmissions from acute exacerbations.

Purpose Little is known about differences in the risk of infertility, family-building patterns, and childcare habits of proceduralists compared to non-proceduralists. This cross-sectional study examines variations in family-building patterns and childcare habits between proceduralists and non-proceduralists. Methods From April to May 2021, a convenience sample of medical students and physicians was recruited through social media and organizational listservs to complete a questionnaire as part of the Study of Physicians and Children: Expectations and Experiences (SPACE). Respondents reported their demographics and family-building path, if applicable. All physicians who indicated their specialty were included. Medical students were excluded. The primary outcomes of interest were the rates of infertility and utilization of assisted reproductive technology (ART). Secondary outcomes included family-building patterns and childcare habits. Procedural vs. non-procedural specialties were categorized based on previously published literature. Results Including trainee physicians, there were 2519 physician respondents (80.8% of all respondents). The majority identified as women (n = 2246, 89.2%) and as heterosexual (n = 2204, 87.5%). There were 1103 (43.9%) proceduralists and 1416 (56.1%) non-proceduralists. The prevalence of infertility was similar across specialty type (26.8% proceduralists vs. 26.5% non-proceduralists, p = 0.66). The use of ART was higher among proceduralists (27.2% vs. 22.6%, p < 0.01). Proceduralists were more likely to have biological children during residency (38.6% vs. 27.3%, p < 0.001) and to be childless despite desiring biological children (38.2% vs. 35.2%, p < 0.001). For childcare, proceduralists were more likely to rely on nannies (50.2% vs. 41.6%, p < 0.002), while non-proceduralists were more likely to use daycare (60.8% vs. 49.4%, p < 0.001). Conclusion This study demonstrates key differences in family-building patterns and the use of ART between procedural and non-procedural physicians. Such discrepancies suggest a need to better support physicians, especially those in procedural specialties, who want to have children by implementing more family-friendly policies.

Background: By allowing for abortion bans and restrictions to take effect in the majority of US states, the 2022 Dobbs v Jackson Women’s Health Organization decision portends to have lasting impacts on patient care and the physician workforce. Notably, it is already beginning to impact practice location preferences of US health care workers, evidenced by declining application rates to residency programs in abortion-restrictive states since 2022. Yet, there remains a gap in the literature regarding why this trend exists. Objective: This study aims to describe what factors are driving the practice location preferences of medical students and physicians after the Dobbs decision. Methods: This study analyzes qualitative data from a web-based, cross-sectional study. In August 2022, a nonprobabilistic sample of physicians and medical students were surveyed on social media about the impact of overturning Roe v Wade on practice location preferences, which included the free-text question “Please share your thoughts about the overturning of Roe v Wade and how it will affect your decision about your (residency/job or fellowship) programs.” A total of 3 independent team members completed an inductive thematic analysis of 524 free responses, resolving differences by discussion. Results: Approximately 1 in 4 survey respondents also completed the free-response item (524/2063, 25.4%); a total of 219 were medical students, 129 were residents and fellows, and 176 were practicing physicians. Of them, approximately half (261/524, 50.5%) resided in states where abortion bans were in place or anticipated. Those who answered the free-response item were relatively more likely to hail from states with restrictive abortion bans (P<.001) compared to those who did not, with other demographic characteristics being largely similar between the groups. Inductive thematic analysis yielded 2 broad thematic categories: patient-related and workforce-related factors influencing practice decision preferences. The 3 most common themes overall were respondent concerns regarding their patient’s access to care (249/524, 47.5%), their desire not to practice or train in a state with abortion restrictions regardless of current residence (249/524, 47.5%), and their personal belief that abortion bans are human rights and/or body autonomy violation (197/524, 37.6%). Some respondents stated that the Dobbs decision would not impact their choice of practice location (41/524, 7.8%), and some supported it (35/594, 6.7%). Conclusions: This study shows that abortion restrictions are having an impact on the practice location preferences of the physician workforce due to both patient care and personal factors. It is important that state policy makers and others who are considering abortion restrictions also consider how to address these concerns of physicians and medical students, to avoid worsening geographic maldistribution of physicians and worsening access to care from physicians for their citizens.

Long and variable work hours are standard in medical residencies worldwide. This schedule often leads to sleep deprivation. Over 3 decades of research

Vineet Arora, MD, MAPP, addressed the Medical School class of 2024, emphasizing leadership, clear communication, advocacy, and continuous learning. She shared personal experiences, highlighting gender equity, self-care, and combating burnout. Arora affirmed the graduates’ roles as leaders dedicated to improving health and healthcare for their patients and communities.

Purpose: The medical education community is pursuing reforms addressing unsustainable growth in the number of residency applications per applicant and application costs. Little research has examined the prevalence or contributions of parallel applications (application to residency in multiple specialties) to this growth. Method: A retrospective analysis of Electronic Residency Application Service data provided by the Association of American Medical Colleges was conducted. The percentage of applicants applying to ≥ 1 specialty, mean number of specialties applied, number of submitted applications, and percentage of applicants to each specialty who were parallel applying were determined. MD, DO, and international (U.S. international medical graduate [IMG] and IMG) applicants were included. Results: The sample contained 586,246 applicant records from 459,704 unique applicants. The percentage of applicants who parallel applied decreased from 41.3% to 35.4% between 2009 and 2021. DO applicants were the only group for whom the percentage parallel applying increased (30.6% vs 32.1%). IMG (60.4% vs 49.1%) or USIMG applicants (69.6% vs 63.1%) were groups with the greatest percentage of applicants parallel applying each year (2009–2021). The mean number of specialties applied to when parallel applying also decreased from 2.96 in 2009 to 2.79 in 2021, overall. Between 2009 and 2021, mean number of applications increased for all applicant types among both single-specialty applicant and parallel-applying applicants. Among applicants who were single-specialty applying, mean number of applications grew from 38.6 in 2009 to 74.6 in 2021 and from 95.2 to 149.8 for parallel-applying applicants. Conclusions: All applicant groups experienced decreases in percentages parallel applying except for DO applicants. Parallel application appears to be common and slowly declining, and does not appear to significantly contribute to increasing numbers of applications per candidate. Efforts to control the growth of applications per applicant should continue to focus on applicants’ numbers of applications submitted to each specialty.