Healthcare practitioners must be trained to collaborate in a dynamic environment where patients are complex and teams can change from day-to-day, but choosing the right measures to assess the effectiveness of interprofessional teamwork among learners is challenging. This study used measures representing four different perspectives to assess student teams in a practice setting where team composition varied each day. We tested the strength of the relationships between these measures, and we examined the impact of additional variables on each measure. Participants were students from different health professions at a single university and patients in a community-based wellness program. We sampled 100 wellness visits where an interprofessional student team met with a patient, and we assessed team effectiveness using student perceptions of their team, patient ratings, observer ratings, and faculty assessments of team healthcare plans for the patient. We calculated bivariate correlations between the four measures and used regression analyses to assess the impact of predictors including student, patient, and clinic/site characteristics, on each measure of team effectiveness. There were small but significant negative correlations between the assessments of faculty and observers (r = - 0.23), as well as between faculty and patients (r = - 0.14). Conversely, a small but significant positive correlation was found between the assessments of patients and observers (r = 0.15). Among the regression models, faculty and patient ratings of team effectiveness were more strongly related to the predictors measured (R-squared = 53.6% and 41.7%, respectively). Patient age and number of clinic visits, team size, and clinic site were significant factors for predicting team effectiveness across the two measures. Our findings provide evidence that different perspectives of team effectiveness measure different constructs. While all approaches have value, in IPE practice settings, team effectiveness should be evaluated with multiple measures to understand performance and identify opportunities for improvement. Teamwork in dynamic healthcare environments is complex, and simple measurement approaches may mischaracterize learning and clinical outcomes.

The learning health system (LHS) model was proposed to provide real-time, bi-directional flow of learning using data captured in health information technology systems to deliver rapid learning in healthcare delivery. As highlighted by the landmark National Academy of Medicine report "Crossing the Quality Chasm," the U.S. healthcare delivery industry represents complex adaptive systems, and there is an urgent need to develop innovative methods to identify efficient team structures by harnessing real-world care delivery data found in the electronic health record (EHR). We offer a discussion surrounding the complexities of team communication and how solutions may be guided by theories such as the Multiteam System (MTS) framework and the Multitheoretical Multilevel Framework of Communication Networks. To advance healthcare delivery science and promote LHSs, our team has been building a new line of research using EHR data to study MTS in the complex real world of cancer care delivery. We are developing new network metrics to study MTSs and will be analyzing the impact of EHR communication network structures on patient outcomes. As this research leads to patient care delivery interventions/tools, healthcare leaders and healthcare professionals can effectively use health IT data to implement the most evidence-based collaboration approaches in order to achieve the optimal LHS and patient outcomes.

In many healthcare settings, teams change composition regularly, so healthcare students must be trained to function effectively in dynamic teams before entering the workforce. Interprofessional clinical rotations provide an ideal venue for learners to practice these skills, but little is known about how student teams interact in such settings. In this qualitative observational evaluation, learners from multiple health professions at a single institution participated in scheduled clinics in low-income housing communities for older adults. Interprofessional student teams met with program participants for care coordination, health and wellness assessments, and assistance in setting and achieving health goals; team composition changed from week-to-week. A purposive sample was selected from video-recorded encounters between student teams and their program participants. The aim of this study was to explore team interactions and document learner behaviors. Two researchers independently reviewed discrete segments of each video, recorded their observations and reflections, and then the team discussed, categorized, and identified relevant examples of both effective and ineffective behaviors. Four major themes were observed: inclusiveness, leadership, joy of practice, and sharing of clinical knowledge. Students demonstrated both positive and negative examples of behaviors that aligned with each theme. Understanding how students behave on teams in dynamic settings where patient care is taking place can help educators establish practice-based interprofessional education models that better prepare learners to function effectively and strategies that may improve team interactions.

BACKGROUND: Recognizing and attempting management of patients with urgent or emergent conditions is one of the Association of American Medical Colleges Core Entrustable Professional Activities (#10) and a skill desired of new interns. However, given the acuity of these patient conditions, medical students often struggle to gain experience in these situations. Virtual reality could help fill this void while lowering costs and resources compared with high-fidelity simulation. METHODS: We converted a high-fidelity chest pain simulation case to virtual reality format utilizing short video clips filmed with a 360 -degree camera and superimposed menus of options at decision points. This virtual reality simulation was offered to fourth -year medical students during their transition to residency course in the spring of 2023. Students were offered a post -survey on the simulation. RESULTS: There were 47 fourth -year students that completed the virtual reality simulation; 41 completed the post -survey (response rate 87.2%). Over 90% of the students agreed or strongly agreed with the following statements: the virtual reality simulation was a valuable part of the transition to residency course, the virtual reality case was similar to what they will face as an intern, and they would like to have more virtual reality simulations earlier in the fourth year; 85.4% agreed or strongly agreed that the virtual reality simulation helped prepare them for the first few days of intern year. CONCLUSIONS: We demonstrated that virtual reality is an acceptable, cost-effective, and feasible modality to teach medical students how to recognize and attempt management of urgent clinical situations (Core Entrustable Professional Activity 10). (c) 2024 Elsevier Inc. All rights reserved. center dot The American Journal of Medicine (2024) 137:454 - 458

While feedback is essential for learning in the health professions, clinical teachers rarely get feedback on their teaching, and the existing feedback is often non-specific and distant from teaching encounters. To enhance clinical teaching, we created a peer assessment program for clinical faculty. This program has been well-received and sustained for five years despite the challenges of faculty turnover and the pandemic. In this article, we identify twelve tips for creating and sustaining a peer assessment program for clinical faculty based on this experience. These tips focus on how to create a culture that supports peer assessment, on how best to implement a peer assessment program in practical terms, and on how to sustain a peer assessment program long-term. We hope these tips help educators receive better feedback about their clinical teaching and improve the future care delivered by our learners.

BackgroundHospital at Home (HaH) is a growing care model requiring significant investments. Critical to starting a program is estimating census and enrollments. The objective of this study was to compare expected versus actual consults, enrollments, and barriers in a novel HaH program.MethodsThis was an observational, retrospective cohort study at a single urban academic medical center. Adult inpatients considered for enrollment to HaH were included. Demographic data, diagnoses and outcomes data were extracted for HaH patients. Volume and outcomes of HaH consults were recorded, including reasons for ineligibility or a patient declining to enroll.ResultsOver the first year of implementation, 248 patients enrolled. The average daily census (ADC) grew over months 1-6, then plateaued at a mean of 4.4 patients during month 10, with an overall ADC range from 0 to 7 patients. From months 7 to 12, there were 724 consults for a home hospital assessment, of which 22.5% (163/724) of patients were enrolled, 21.8% (158/724) declined to enroll, 29.3% (212/724) were ineligible for the program, and 26.4% (191/724) had consults that were deferred until the time of discharge and never explicitly consented or refused. The most common reasons for program ineligibility were complex care needs, insurance status, and not meeting inpatient status. The most common reasons patients declined to enroll were a preference to remain in the brick-and-mortar hospital and home conditions not suitable for HaH.ConclusionsThis retrospective, cohort study defines the challenges of enrolling patients in an HaH program and provides areas for other programs to examine as they start or grow a program.

Inconsistent reporting of IPE study variables hampers replicability and generalizability of interprofessional education (IPE) research. The purpose of this review was to develop an evidence-based list of IPE variables that allows researchers to account for variability in learning environments and outcomes across institutions. A systematic database search was conducted, narrowing to 17 relevant IPE articles. IPE terms were identified in each article. A final list of variables was agreed upon and categorized using Fink's guide for significant learning experiences. Forty-three variables were identified and classified into the four categories: identifying situation factors, identifying learning goals, formulating assessment procedures, and selecting effective learning activities. An IPE variable list was developed for consistent activity reporting by educators and researchers. Implementation and subsequent refinement of these variables would assist in establishing a format for reporting of IPE scholarly work that better supports the advancement of interprofessional science.

Introduction: This study aimed to characterize practitioners who use podcasts as a form of continuing education (CE), evaluate attitudes regarding podcasting as a medium for CE, and assess intended practice change after listening to podcasts for CE. Methods: We examined CE data from a mandatory postpodcast evaluation collected between February 2021 and August 2021 for two free podcasts. We analyzed linked episode data containing podcast downloads. Results: Listeners downloaded 972,691 episodes and claimed 8182 CE credits (less than 1% of total downloads) over 7 months. CE credit was claimed by physicians, physician assistants, nurses, and pharmacists. Most listeners claiming CE credit were not affiliated with an academic institution. Motivation for listening to episodes included a topic of interest, relevance to a patient, and a topic of less comfort. Of individuals obtaining CE, 98% intended to implement change after listening. Discussion: Although only a small number of podcast listeners claim CE credit, those who claim credit represent a diverse and interprofessional audience. Listeners select podcasts to fill self-identified learning needs. Overwhelmingly, listeners report podcast CE changes intended practice. Podcasts may be an effective modality for CE and practice change; further research should focus on facilitators and barriers to CE uptake and on patient health outcomes.

KEYWORDS: Checklistcomparative researchframeworkinterprofessional educationlearning environmentreplication

Interprofessional case competitions exist that allow students from different disciplines to collaborate and compete against teams from other institutions. These competitions have focused on addressing public health problems, rather than patient-specific clinical issues, and they have been limited to students in the U.S. This short communication describes the inaugural International Interprofessional Case Competition (I2C2), which brought advanced learners together from six institutions across three countries. Each participant was assigned to a multi-national interprofessional team, and each team collaborated to analyze a fictional, complex patient case and construct a cohesive interprofessional plan of care, which they presented to a panel of faculty judges. The quality of the teams’ efforts were evidenced by high ratings from judges, and student evaluations of the experience were generally positive. Some areas for future improvement include providing a more comprehensive orientation session and addressing the logistical challenges of working across time zones and at a distance. Overall, this activity successfully brought together students in a uniquely diverse and positive learning experience.

Interprofessional education (IPE) prepares health students to become collaboration-ready healthcare professionals. Assessing students' baseline attitudes toward IPE and collaborative practice is essential to inform development of IPE curricula. Kuwait University Health Sciences Center (HSC) is early in its IPE journey but is planning to join the broader global movement toward IPE. A cross-sectional survey was conducted to explore the attitudes of HSC students from Faculties of Medicine, Dentistry, Pharmacy, and Allied Health Sciences toward collaborative practice and IPE at early and late stages of study. A total of 770 students completed the survey (81.1% response rate). Students expressed positive attitudes toward interprofessional healthcare teams and IPE (median [IQR] overall attitudes were rated 4.0 [1.0] and 4.0 [2.0], respectively, on a scale of 5). Overall attitudes toward both scales were significantly more positive among pharmacy students than students from other faculties (p < .001). Final-year students reported more positive attitudes toward healthcare teams than early- and middle-year students, while early- and final-year students expressed more positive attitudes toward IPE than middle-year students (p < .001). There were no significant differences in overall attitudes between female and male students toward the two scales (p > .05). These findings have implications for engaging students from different professions in IPE initiatives.

Purpose To improve understanding of podcast use in medical education by examining current research on descriptive attributes and educational outcomes, highlighting implications of the current evidence base for educational practices, and identifying research gaps to guide future investigation. Method The authors conducted a scoping review, searching PubMed and Embase databases in June–July 2020 for English-language studies of audio-only medical education podcast use in undergraduate, graduate, and continuing medical education. The authors excluded studies without original data or with nonphysician data that could not be separated from physician data. From included studies, the authors extracted data regarding descriptive outcomes (e.g., podcast use, content areas, structure) and educational outcomes (classified using Kirkpatrick’s 4 levels of evaluation). Results Of 491 unique articles, 62 met inclusion criteria. Descriptive outcomes were reported in 44 studies. Analysis of these studies revealed podcast use has increased over time, podcasts are a top resource for resident education, and podcasts are being incorporated into formal medical curricula. Educational outcomes were reported in 38 studies. The 29 studies that assessed learner reaction and attitudes to podcasts (Kirkpatrick level 1) showed learners value podcasts for their portability, efficiency, and combined educational and entertainment value. The 10 studies that assessed knowledge retention (Kirkpatrick level 2) showed podcasts to be noninferior to traditional teaching methods. The 11 studies that assessed behavior change (Kirkpatrick level 3) showed improved documentation skills in medical students and self-reported practice change in residents and practicing physicians after listening to podcasts. None of the studies reported system change or patient outcomes (Kirkpatrick level 4). Conclusions Future research should focus on the optimal structure of podcasts for learning, higher-level outcomes of podcasts, and the implementation of podcasts into formal curricula. Podcasts may prove to be essential tools for disseminating and implementing the most current, evidence-based practices.

Variability in the widespread utilization and implementation of the Interprofessional Education Collaborative's (IPEC) competency framework has highlighted the importance of institutional characteristics that serve as barriers and/or facilitators to progress, as well as the absence of evidence-based assessment instruments designed to measure related constructs. Develop and validate an assessment instrument that leverages the IPEC competency framework to identify institutional characteristics associated with successful implementation of high-quality programmatic interprofessional education (IPE). A 16-member expert panel used a modified Delphi technique to generate consensus statements regarding institutional characteristics associated with high-quality programmatic IPE, which were converted into a pool of items for potential inclusion in the instrument. A convenience sample of individuals who serve as the designated IPE leader at their academic institutions voluntarily submitted responses to these items on behalf of their institutions, and exploratory factor analysis (EFA) was utilized to identify a preliminary model structure for the instrument. 105 consensus statements across eight categories – culture, leadership, financing, infrastructure, partnerships, faculty affairs, curricular affairs, and IPEC competency framework – were developed by the expert panel, then transformed into 48 potential instrument items. 158 designated IPE leaders submitted responses as institutional representatives, and EFA yielded a 20-item model structure comprised of three factors: Institutional Infrastructure, Institutional Commitment, and IPEC Competency Framework. Leaders of academic institutions are encouraged to utilize the 20-item IPEC Institutional Assessment Instrument alongside the 105 expert-generated consensus statements it is based upon to assess their institutional capacity for high-quality programmatic IPE and to plan for quality improvement.

Introduction Medical schools vary in their approach to providing feedback to faculty. The purpose of this study was to test the effects of rapid student feedback in a course utilizing novel virtual learning methods. Methods Second-year medical students were supplied with an optional, short questionnaire at the end of each class session and asked to provide feedback within 48 h. At the close of each survey, results were emailed to faculty. After the course, students and faculty were asked to rate the effectiveness of this method. This study did not affect administration of the usual end-of-course summative evaluations. Results Ninety-one percent of students who participated noted increased engagement in the feedback process, but only 18% on average chose to participate. Faculty rated rapid feedback as more actionable than summative feedback (67%), 50% rated it as more specific, and 42% rated it as more helpful. Some wrote that comments were too granular, and others noted a negative personal emotional response. Conclusion Rapid feedback engaged students, provided actionable feedback, and increased communication between students and instructors, suggesting that this approach added value. Care must be taken to reduce the student burden and support relational aspects of the process.

Social Determinants of Health (SDOH) impact health outcomes; thus, a pilot to screen for important SDOH domains (food, housing, and transportation) and address social needs in hospitalized patients was implemented in an urban safety-net academic medical center. This study describes the pilot implementation and examines patient characteristics associated with SDOH-related needs. An internal medicine unit was designated as a pilot site. Outreach workers approached eligible patients (n = 1,135) to complete the SDOH screening survey at time of admission with 54% (n = 615) completing the survey between May 2019 and July 2020. Data from patient screening survey and electronic health records were linked to allow for examination of associations between SDOH needs for food, housing, and transportation and various demographic and clinical characteristics of patients in multivariate logistic regression models. Of 615 screened patients, 45% screened positive for any need. Of 275 patients with needs, 33% reported needs in 2, and 34% - in 3 domains. Medicaid beneficiaries were more likely than patients with private health insurance to screen positive for 2 and 3 needs; Black patients were more likely than White patients to screen positive for 1 and 3 needs; Patients with no designated primary care physician status screened positive for 1 need; Patients with a history of substance use disorder screened positive for all 3 needs. SDOH screening assisted in addressing social risk factors of inpatients, informed their discharge plans and linkage to community resources. SDOH screening demonstrated significant correlations of positive screens with race/ethnicity, insurance type, and certain clinical characteristics.

The “Things We Do for No ReasonTM (TWDFNR)” series reviews practices, which have become common parts of hospital care, may provide little value to our patients. Practices reviewed in the TWDFNR series do not represent “black and white” conclusions or clinical practice standards, but are meant as a starting place for research and active discussions among hospitalists and patients. We invite you to be part of that discussion. Pulmonary function testing (PFT) is used to evaluate lung health through the measurement of airflow and volumes. They help confirm clinical diagnoses like chronic obstructive pulmonary disease (COPD) and asthma and monitor response to therapy and progression of the disease. Lung volumes vary widely across a population and must be compared to reference values to determine the degree of lung health. Common reference values incorporate variables such as age, height, sex, and race.1 Lung volume reference values for Black/African American (AA) patients are typically 10%–15% lower than values for Caucasian patients.2 Spirometry reference equations recommend using norms derived from the National Health and Nutrition Examination Survey (NHANES), which provides values for Caucasians, Black/AA, and Mexican Americans.3 NHANES does not include reference values for Asian American patients due to inadequate representation.3 Subsequent studies attempted to set a standard for Asian patients, but the standardized correction factor varied widely from 0.88 to 0.94 times the reference values for Caucasians.2, 4, 5 In developing spirometry, various studies from the last century identified differences in lung function among races leading to the implementation of race adjustment factors.3 Health care providers often use skin color as a proxy for genetic risk of common conditions and diseases. The examples of sickle cell disease, colon cancer, or cystic fibrosis clustering in racial groups help support the notion. Researchers applied these beliefs to lung function testing. The race adjustment factor for PFTs is harmful because: (1) accepting the race factor impedes the examination of other social, environmental, and genetic factors as drivers of disease, (2) it leads to the underdiagnosis of pulmonary disease in racial minority patients and impacting timely diagnosis, access to effective treatments, and ultimately outcomes,6 and (3) it continues the focus on race, a social construct that imprecisely categorizes people, instead of population categories that group by genetic clusters. The race adjustment in PFTs prevents us from truly exploring the perception, rooted in slavery and eugenics, that Black patients have smaller lung volumes. Many practitioners even remain unaware that race factor exists for PFTs. Modern PFT equipment and software thought to produce “objective data” automatically apply race factors in the background, invisible to providers. Yet a closer examination identifies that structural racism and underlying structural and social determinants of health (SDOH) such as exposure to air pollution, types of employment, and lack of access to preventative healthcare contribute to differences in benchmark PFT values.7-9 One systematic review and meta-analysis showed that ‘low socioeconomic circumstances were associated with a 0.31 L reduction in forced expiratory volume in the first second (FEV1).9 We must practice race-conscious medicine, where we purposefully acknowledge systemic and institutional racism's effect on our patients and move towards abolishing these practices. Additionally, race adjustments can lead to clinical harm through underdiagnosis. In a study of biracial children, there was a 16.5% difference in forced vital capacity (FVC) when classified as “Black” compared to when they were reclassified as “White.” Some patients met the criteria for obstructive disease only when classified as White.10 Another study that examined 14,080 PFTs of individuals who identified as Black or African-American found that removing the race adjustment led to an additional 414 patients diagnosed with obstructive disease and 665 patients diagnosed with restrictive disease. This correlates to a 1.7% and 4.7% increase in the prevalence of obstructive and restrictive disease, respectively. Furthermore, among Black patients already diagnosed with an obstructive, restrictive, or mixed pulmonary defect, nearly half would then be diagnosed with higher severity of disease such as COPD.11 In a 10+ year study following over 3000 patients, FEV1 or FVC percentages using race-based equations do not improve prediction of chronic lower respiratory diseases and mortality compared to race-neutral equations.12 In fact, people identifying as Black may have more emphysematous changes on computed tomography (CT) despite normal spirometry.13 Race-based underdiagnosis of COPD may also lead to race-based increases in rates of lung cancer mortality. In a study from Detroit, MI, 78% of AA individuals with lung cancer who did not report a previous diagnosis of COPD had clinical evidence of COPD.14 Since lung diseases such as COPD confer an increased risk of lung cancer, receiving appropriate care for COPD may decrease the risk of future lung cancer through more aggressive smoking cessation and accelerated efforts for early detection through screening.15 Assigning or assuming a patient's race imprecisely or inaccurately categorizes individuals. Our patients are members of a diverse global community. Self-identified race is a socially accepted standard, yet there are no reference values for self-identified race. When a categorical race structure limits the choices, many patients will not find a race category that fits their diverse identity or correctly identifies their underlying genetics.10 For example, there are no standardized reference values for biracial individuals.10 Attempting to create reference PFT levels for “Asians” highlights the inaccuracy and variability that occurs when one race label is applied to a diverse population. Racial proxies assume all patients of one racial category meet the same epidemiologic parameters. Little effort has been made to distinguish subgroups of “Asian” individuals or “Black” individuals or account for genetic and geographic differences within Asia and Africa.5, 10 As our understanding of genetics has evolved in the era of modern medicine, we have moved away from the categorization of populations based on race or skin color toward clusters of genetic variation and ancestry. We now know that most genetic variability occurs between individuals, and little is explained by race.7 Research shows that using genetic markers indicating African ancestry leads to more accurate predictions of lung function than those derived from the standard reference equation based on an “African American” race category.16 Our medical technology and references must adapt accordingly to better inform clinical decision-making. Some worry that removing the race factor will lead to overdiagnosis. However, the risks of overdiagnosis of lung disease are outweighed by the risks of underdiagnosis and it is uncommon for a diagnosis to be made on PFT values alone. It is known that underdiagnosis is common, has its roots in racism, contributes to increased morbidity and mortality for under-represented minority patients, and the evidence supporting race correction is poor quality and has racist roots.7, 8, 11, 14 Research has not identified a genetic variation that can explain racial differences in lung functions. Multiple studies, however, show the effect of socioeconomic status, environmental toxins, and other SDOH.8, 9 While additional research is needed to further quantify the impact of SDOH, the medical community should not continue to use race as an inaccurate proxy for the differences in lung capacity. The medical community should follow the lead of other equations, like eGFR estimation and the VBAC calculator, which have successfully removed race factors.17 Cease using the race factor in calculating PFTs. If your institution uses spirometers with a race factor, enter every patient as “White” to apply a race factor of 1. Inform patients whenever a race factor is applied in assessing their health. Advocate for the development and manufacturing of spirometers that do not include race factors. Advocate for further research into the relationship between lung capacity and social determinants of health that disproportionately impact people of color. Utilize an individualized and patient-centered approach to the diagnosis of pulmonary disorders and inquire about social factors that increase the risk of lung disease. In our clinical scenario, a deeper look into our patient's history reveals that he lives in a community with high levels of pollutants, previously worked at a chemical plant, and has difficulty finding high-quality housing. A more nuanced approach to the diagnosis of COPD would have valued these historical factors. Closer follow-up might have led to more adequate medication therapy, quicker integrations of newer therapies, and more comprehensive care, including screening for lung cancer. PFT is an important component of diagnosing a variety of diseases and assessing patients' lung health. Understandably, many healthcare practitioners may have concerns about unintentional harm caused by removing the race adjustment. However, supporting race adjustment perpetuates healthcare disparities. As a profession, we must practice race-conscious medicine that values individualized care, recognizes the contributions of structural racism and social determinants in patient health, and standardize care when possible, based on objective metrics. What do you do? Do you think this is a low-value practice? Is this truly a “Thing We Do for No Reason™”? Share what you do in your practice and join in the conversation online by retweeting it on Twitter (#TWDFNR) and liking it on Facebook. We invite you to propose ideas for other “Things We Do for No Reason™” topics by emailing [email protected]. The hospitalist admitted a 49-year-old man with a 20-pack-year history of tobacco use and chronic cough for a viral illness featuring dyspnea and hypoxia. After a short observation period, his symptoms resolved, but the hospitalist suspects that the patient has COPD and refers him for PFT. His PFT results, using race adjustment to account for his black race, do not meet the criteria for a diagnosis of COPD. As a result, he only receives tobacco cessation counseling from his primary care physician. He continues to have a chronic cough with sputum production but does not receive COPD-specific therapies and is lost to follow-up after finding out he does not have COPD. The authors declare no conflict of interest.

The national struggles for social justice that have dominated headlines since 2020 are reflected in the challenges academic health centers are confronting as they strive to become more antiracist. One of the largest challenges for these institutions may be the inertia of the status quo. While faculty may have become accustomed to a status quo that perpetuates inequity, students provide perspectives that can disrupt this inertia and lead to positive change. Students, however, face barriers to antiracist work, including power gradients (i.e., different amounts of power people possess according to their position in a hierarchy) and a need to be accepted as part of the physician profession. In this article, the authors examine these challenges to student antiracist advocacy. They identify student empowerment, faculty allyship, and sustainability as essential principles for student antiracist work. They suggest this work could be operationalized through sequential student-led task forces focused on addressing the most pressing antiracist issues. The authors further recommend an approach to professionalism and development of a physician professional identity based on the values of antiracism rather than on existing norms. With this foundation, students may be able to engage in antiracist work, build professional identities that are more antiracist, and become physicians who can ensure a more just health care environment for their patients and communities.

Background Screening for food insecurity (FI) and providing nutrition care are important management strategies for chronic diseases, but rates are low. Aspects of team-based care and providers' nutrition competence may help inform interventions to improve these services. The objectives of this study were to describe US primary care providers' FI screening and nutrition care practices (counselling, referrals, and time spent counselling) and test for associations with scored measures of their perceptions of team-based care (care continuity, patient-centredness, coordination with external providers and resources) and nutrition competence (confidence counselling and attitudes towards nutrition). Methods Cross-sectional online survey data of primary care providers were described and analysed for associations using Wilcoxon rank sum tests. Results Of provider respondents (N = 92), 35% (n = 32) worked in clinics that screen for FI and had higher team perceptions (P = 0.006) versus those who do not. Those who reported counselling >30% patients about nutrition (57%, n = 52) and referring >10% patients to nutrition professionals (24%, n = 22) had significantly better attitudes towards nutrition (P = 0.013 and P = 0.04, respectively) compared with those with lower counselling and referral rates. Half (n = 46) of the providers reported spending >3-min counselling each patient about nutrition and had higher patient-centred care (P = 0.004) and nutrition competence (P < 0.001) compared with those who spent less time counselling. Conclusion Providers in clinics that screen for FI had higher overall perceptions of team-based care, but their nutrition competence was not significantly different. Meanwhile, reported more time counselling was associated with a culture of patient-centredness. Promoting team-based care may be a mechanism for improving FI screening and nutrition care.

While educational escape rooms are a novel way to stimulate collaboration and enhance team learning, this approach has only been described a few times in the health professions and interprofessional education literature and has tended to be resource intensive. In this report, we describe two educational escape rooms built using freely available technology and implemented with two different cohorts of interprofessional learners in large-scale courses of over 500 students. We sought to demonstrate that a screen-based or virtual escape room approach was feasible, flexible in terms of content and format, and engaging for learners collaborating in small group teams.