BACKGROUND:Breast arterial calcification (BAC), detected by digital mammography, has been strongly associated with coronary artery disease (CAD). Meta-analyses have estimated BAC prevalence to range from 12.7%-17.1%, yet these estimates include women with known cardiovascular conditions. The percentage of women in a screening population with BAC who might benefit from formal cardiovascular evaluation is unknown. OBJECTIVE:To determine the prevalence of, and factors associated with BAC in a sample of patients without a history of coronary artery disease (CAD), prior myocardial infarction or heart failure, prior stroke or TIA, atrial fibrillation or angina with or without prescribed nitroglycerin (i.e., without a Major Adverse Cardiovascular Event +, named MACE+). And to clarify the percentage of mammography patients who could benefit from cardiovascular assessment. METHODS:4304 mammography patients without MACE+ history were enrolled. BAC presence/absence and demographic/medical history information was collected. RESULTS:BAC prevalence was 8.04%. Age was a significant risk factor for BAC. Age-adjusted analyses revealed: 1) increased BAC prevalence in Black and Hispanic women, 2) decreased BAC prevalence in Ashkenazi women and women with current HRT use, and 3) no association between BAC prevalence and menopausal status, age of menarche, or breast density. CONCLUSIONS:An 8% BAC prevalence suggests that more than half of women with BAC likely have no history of diagnosed cardiovascular conditions, and BAC might be the first indication they should be referred for formal cardiovascular evaluation. For the 1 in 12 women without MACE+ but with BAC, communicating BAC results could alert them to cardiovascular concerns and encourage them seek out preventive cardiology care, making BAC communication an important public health intervention.

Abstract The potential for behavioral science to make meaningful strides in cancer prevention and control is significant, yet more behavioral scientists focused on cancer prevention and control are desperately needed to achieve this end. Unfortunately, progress in behavioral cancer prevention and control (BCPC) research is hampered by several key barriers. These include: 1) the relatively small fraction of scientists who focus on BCPC, 2) limited awareness of BCPC career opportunities when college students consider their advanced educational options, 3) limited opportunities to receive formal early training in BCPC research, and 4) a lack of stewardship of outstanding college students to transition from research labs to successful graduate education. The objective of STANDOUT (Summer Training Accelerating and Nurturing the Development of Outstanding Undergraduate Trainees; R25CA260125) is to address institutional challenges head-on, by providing multifaceted, immersive summer training and career development opportunities to talented undergraduates attending Hunter College, a large diverse urban university in New York City. Now in its third year, we report on trainee outcomes to date. Undergraduate Trainees (n=41, 16-18/cohort) completed a 10-week summer research internship program. The program includes: 1) formal mentored BCPC research training with scientists at either Hunter College of the City University of New York or the Center for Behavioral Oncology at the Icahn School of Medicine at Mount Sinai, 2) biweekly research and career development seminars, 3) research and networking conferences, and 4) continued outreach and mentoring as students advance in their education and training. We conducted pre-post assessments of key outcomes, as well as program satisfaction, and annual follow-ups to track student advancement and accomplishments. Findings indicated that trainees consistently endorsed high levels of satisfaction across multiple program elements, including mentor quality, research experience, and seminars and conferences. Trainees also exhibited significant increases in a number of key research-related skills, including conducting literature reviews, writing, generating and refining hypotheses, conducting quantitative analyses, and presenting research. Notably, trainees’ interest in pursuing cancer research increased significantly following the program. Finally, annual follow-up data revealed continued interest in BCPC research, increases in related professional activities, presentations, publications, attendance at scientific conferences, and career and academic advancement (e.g., successful application to graduate programs). STANDOUT is an example of a program that can both train and inspire students early in their academic trajectories to pursue careers aimed at advancing research in behavioral cancer prevention and control. Citation Format: Joel Erblich, Jennifer S. Ford, Guy H. Montgomery. The STANDOUT program: A model for undergraduate training and career development in behavioral cancer prevention and control [abstract]. In: Proceedings of the American Association for Cancer Research Annual Meeting 2026; Part 1 (Regular Abstracts); 2026 Apr 17-22; San Diego, CA. Philadelphia (PA): AACR; Cancer Res 2026;86(7 Suppl):Abstract nr 7568.

Identifying systemic disease with medical imaging studies may improve population health outcomes. Although the pathogenesis of peripheral arterial calcification and coronary artery calcification differ, breast arterial calcification (BAC) on mammography is associated with cardiovascular disease (CVD), a leading cause of death in women. While professional society guidelines on the reporting or management of BAC have not yet been established, and assessment and quantification methods are not yet standardized, the value of reporting BAC is being considered internationally as a possible indicator of subclinical CVD. Furthermore, artificial intelligence (AI) models are being developed to identify and quantify BAC on mammography, as well as to predict the risk of CVD. This review outlines studies evaluating the association of BAC and CVD, introduces the role of preventative cardiology in clinical management, discusses reasons to consider reporting BAC, acknowledges current knowledge gaps and barriers to assessing and reporting calcifications, and provides examples of how AI can be utilized to measure BAC and contribute to cardiovascular risk assessment. Ultimately, reporting BAC on mammography might facilitate earlier mitigation of cardiovascular risk factors in asymptomatic women.

BACKGROUND:Breast cancer surgery is often associated with unpleasant postoperative symptoms, including pain, nausea, fatigue, and emotional distress, which can reduce quality of life and prolong recovery times. This study aimed to test the efficacy of preoperative hypnosis in reducing postoperative symptoms after breast cancer surgery. METHODS:A total of 203 women scheduled for breast cancer surgery at Oslo University Hospital in Oslo, Norway, participated in a randomized controlled trial. Patients were randomized to receive a single session of either preoperative hypnosis or mindfulness within 2 h before their scheduled surgery. Primary outcomes were postoperative pain, fatigue, nausea, discomfort, and emotional distress, measured using 100-mm visual analog scales on the day of surgery after recovery from general anesthesia. Additional measures included amount of intraoperative and postoperative anesthesia and analgesia, as well as surgery duration (extracted from patients' medical records). RESULTS:Patients receiving preoperative hypnosis reported significantly lower postoperative fatigue (mean difference [MD], 6.4; 95% CI, 0.40 to 12.4; Cohen's d = 0.30) and emotional distress (MD, 5.7; 95% CI, 0.24 to 11.2; d = 0.24) when compared to patients in a mindfulness control group. There was also a significant reduction in postoperative fentanyl use among those patients receiving preoperative hypnosis (MD, -0.03; 95% CI, -0.047 to -0.005; d = 0.54). Preoperative anxiety moderated the effect of hypnosis on postoperative emotional distress, showing a more pronounced benefit for patients with high levels of preoperative anxiety. However, no significant differences were found in postoperative pain, nausea, or discomfort between the hypnosis and mindfulness groups. No adverse events attributed to the interventions were reported. CONCLUSIONS:A brief preoperative hypnosis session before breast cancer surgery appears to be more effective than mindfulness in reducing postoperative fatigue, emotional distress, and fentanyl dose. Hypnosis stands out as a promising, nonpharmacologic, and safe intervention for reducing certain postoperative symptoms.

The field of hypnosis has intrigued clinicians and researchers alike for more than 200 years. Below, a review of hypnosis is presented from historical, theoretical, experimental, and clinical perspectives in order to provide those readers less aware of the field with a broad foundation. The literature reveals that while theoretically driven experimental research has led to groundbreaking clinical applications, there remains much to be done regarding dissemination of efficacious interventions and our understanding of underlying mechanisms responsible for observed effects. The goal is to inspire readers to pursue innovative work to improve our understanding of hypnosis and the quality of life of patients through clinical application. Along the way, we highlight empirical findings and selective writings of Dr. Steven Jay Lynn who was a tireless champion of hypnosis and psychotherapy.

Hypnosis is vastly underused despite strong evidence supporting its efficacy in the context of cancer care. Little is known about what providers need to feel confident moving from education in hypnosis to using hypnosis in clinical care. The goal of this study was to examine cancer care providers' ongoing needs post-hypnosis training to inform the development of future hypnosis training programs. We qualitatively examined open-ended responses about post-training implementation from trainees (n = 70) of our Hypnosis for Cancer Pain training program. Data were analyzed using inductive thematic analysis. Four main themes regarding challenges to real-world implementation of clinical hypnosis were identified: 1) How do I "pitch" hypnosis to the people in my health system?; 2) How do I conduct hypnosis in my native habitat (aka the messy, imperfect real world)?; 3) How do I move "off-book" and improvise?; and, 4) I'd feel more secure with a "buddy system." These challenges have direct implications for the development of future hypnosis training programs to better facilitate post-training provider implementation.

OBJECTIVE:Breast and pelvic cancer patients commonly experience sexual dysfunction post-treatment. This study qualitatively examined breast and pelvic cancer survivors' preferences for the delivery and content of psychosexual interventions to address their sexual health concerns post-cancer treatment. METHODS:We conducted one-on-one, semi-structured qualitative interviews with 35 female and gender-diverse breast and pelvic cancer survivors who had completed radiotherapy at least 12 months prior to enrollment. Data were analyzed using thematic analysis. RESULTS:Patients preferred a therapist who specialized in sexual health to help them with their sexual concerns. Patients preferred to engage in psychosexual interventions after active treatment was complete. While some patients expected to receive validation and support from a psychosexual intervention in a group format, other patients preferred a one-on-one format due to cultural values which stressed the importance of keeping sexual health concerns private. Finally, patients had several preferences for psychosexual intervention content based on their current unmet psychosexual needs: (a) psychosexual education, (b) help with managing negative thoughts and emotions around sex, (c) communication skills around sex, and (d) help with being flexible in the face of sexual side effects. CONCLUSIONS:This study highlights the importance of integrating medical and psychosexual support for breast and pelvic cancer survivors. These results indicate a need to improve training for mental health providers in assessing and treating sexual health concerns, to examine how cultural values may impact patients' preferences for engaging in psychosexual interventions, and to consider the potential impact of sexual script flexibility interventions in this population.

The aim of this study was to test the efficacy of a three-session hypnosis intervention to manage musculoskeletal pain (MSP) in breast cancer survivors taking aromatase inhibitors (AIs). We hypothesized that patients in the hypnosis group would have lower levels of pain than patients in an attention control group. A secondary outcome was to examine intervention effects on AI adherence. Patients (n=154) were randomly assigned to a hypnosis (n=76; mean) or to an attention control (n=78; mean) group. MSP was measured at five time points (baseline, 3, 6, 9, and 12 months) using the BPI-SF (severity, primary outcome), the BPI-SF (interference), the WOMAC, the AUSCAN and the BCPT-MS. AI adherence was measured using eCAPs and self-report (MARS). The hypnosis group had significantly lower BPI-SF severity (p< 0.01) and interference (p< 0.03) scores across assessment points. The AUSCAN [total (p< 0.01), pain (p< 0.01), stiffness (p< 0.04), and function (p< 0.04)] and the BCPT-MS (p< 0.001) scales showed similar results in favor of hypnosis. WOMAC pain (p< 0.02) and stiffness (p< 0.01) subscales were also in favor of the hypnosis group, but differences on WOMAC function were non-significant (p >0.11). AI adherence scores did not differ between the groups (eCAP p >0.80, MARS ps >0.18). Results support hypnosis as efficacious for controlling MSP in breast cancer survivors taking AIs. Hypnosis is brief, has no specific side-effects, can be taught to patients to use on their own, and its beneficial effects persist long after the last intervention session.

Background: While it is often presumed that undergoing breast reconstruction (BR) after mastectomy has positive psychosocial effects, a comprehensive review of current knowledge on the topic is to date absent. The aim of this systematic review is to summarize the available literature on the effects of BR on postoperative psychological distress. Methods: A systematic review of the literature was performed using PubMed, Google Scholar, EMBASE, PSYCinfo, and Web of Science. Inclusion criteria included clinical studies of patients who underwent BR post-mastectomy with psychological distress assessments as primary outcomes. Articles were independently reviewed and assessed for bias and evidence quality. Analyses were performed among patients receiving mastectomy alone (MA) versus mastectomy with breast reconstruction (MBR), immediate versus delayed mastectomy, and implant-based versus autologous reconstruction. Results: Ninety-nine studies published from 1980-2021 met inclusion criteria and were reviewed. Twentysix (26.3%) studies compared patients who underwent MBR to those who underwent MA. Of these, 18 (69.2%) found that MBR had superior effects on psychologic outcomes, 6 (23.1%) found no differences, and 2 (7.7%) found negative psychologic effects relative to MA. Fourteen (14.1%) studies compared immediate versus delayed BR, of which 4 (28.6%) found that immediate BR had superior psychologic outcomes while 10 (71.4%) found no significant differences. Sixteen (16.2%) studies compared autologous versus implant-based reconstruction. Eight (50.0%) of these reported patients with autologous BR were more satisfied with breast appearance. Conclusions: While findings are not uniform, the majority of studies found that BR following mastectomy improves psychologic outcomes, with a possible benefit of immediate over delayed BR. Future studies should determine if BR type has an effect on psychological distress.

Background Distress is highly prevalent among patients with cancer, but supportive care needs often go unmet. Digital therapeutics hold the potential to overcome barriers in cancer care and improve health outcomes. Objective This study conducted a randomized controlled trial to investigate the efficacy of Mika, an app-based digital therapeutic designed to reduce distress across the cancer trajectory. Methods This nationwide waitlist randomized controlled trial in Germany enrolled patients with cancer across all tumor entities diagnosed within the last 5 years. Participants were randomized into the intervention (Mika plus usual care) and control (usual care alone) groups. The participants completed web-based assessments at baseline and at 2, 6, and 12 weeks. The primary outcome was the change in distress from baseline to week 12, as measured by the National Comprehensive Cancer Network Distress Thermometer. Secondary outcomes included depression, anxiety (Hospital Anxiety and Depression Scale), fatigue (Functional Assessment of Chronic Illness Therapy-Fatigue), and quality of life (Clinical Global Impression-Improvement Scale). Intention-to-treat and per-protocol analyses were performed. Analyses of covariance were used to test for outcome changes over time between the groups, controlling for baseline. Results A total of 218 patients (intervention: n=99 and control: n=119) were included in the intention-to-treat analysis. Compared with the control group, the intervention group reported greater reductions in distress (P=.03; ηp²=0.02), depression (P<.001; ηp²=0.07), anxiety (P=.03; ηp²=0.02), and fatigue (P=.04; ηp²=0.02). Per-protocol analyses revealed more pronounced treatment effects, with the exception of fatigue. No group difference was found for quality of life. Conclusions Mika effectively diminished distress in patients with cancer. As a digital therapeutic solution, Mika offers accessible, tailored psychosocial and self-management support to address the unmet needs in cancer care. Trial Registration German Clinical Trials Register (DRKS) DRKS00026038; https://drks.de/search/en/trial/DRKS00026038

INTRODUCTION:Many women with cancer struggle with sexual side effects during and after treatment. Although preliminary evidence indicates that psychosocial interventions may be efficacious in improving sexual functioning for women with cancer, no systematic review has summarized the state of the science in this area. OBJECTIVES:The primary goal of this review was to narratively synthesize the results of randomized controlled trials (RCTs) testing the efficacy of psychosocial interventions to address sexual dysfunction in women with cancer. A secondary goal was to describe the diversity of the included samples (ie, racial/ethnic and sexual minority). METHODS:Following the PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) guidelines, a systematic review was conducted examining RCTs of psychosocial interventions to improve sexual functioning for women with cancer. Articles were identified using MEDLINE, Embase, PsycINFO, and Cochrane CENTRAL. Two reviewers independently assessed each article for inclusion, with a third to resolve discrepancies. RESULTS:Seventeen studies were included in the review, 12 of which provided sufficient information to calculate effect sizes. Ten of the 12 studies primarily aimed to improve sexual functioning, all of which demonstrated positive effects on at least 1 outcome of sexual functioning. In the 2 RCTs of psychosocial interventions in which sexual function was a secondary aim, effects were negligible (ds = -0.04 and -0.15). Commonalities among the studies with large effect sizes were that they included education, mindfulness/acceptance, and communication/relationship skills as intervention components. Of note, there was an overall lack of sample diversity across studies, and most studies failed to report the race/ethnicity or sexual orientation of the participants. CONCLUSION:Results support interventions targeting sexual functioning outcomes for women with cancer and suggest that multimodal interventions including education, mindfulness/acceptance, and communication/relationship skills may be most effective. Future research should also focus on examining the efficacy and potential adaptations of extant sexual functioning interventions for underrepresented groups.

Abstract Objective To assess prevalence of elevated blood pressure readings, rates of established hypertension diagnosis, and blood pressure control medication prescription rates in a cohort of older people experiencing unsheltered homelessness presenting to a Street Medicine clinic in Miami‐Dade County, Florida. In addition, we will compare outcomes found in the study cohort to that of the general population. Methods Demographic information, clinical history, blood pressure control medication prescription, and blood pressure measurements were taken by a Street Medicine team of medical providers. The team routinely provides medical evaluations and care for people experiencing unsheltered homelessness who reside in rough sleeper tent encampments located on the street. Clinical information and vitals were recorded in REDCap. De‐identified data from patients 65 years and above were downloaded and compared to a general population data set—the Centers for Disease Control National Health and Nutrition Examination Survey (CDC NHANES) 2017–2020 Pre‐pandemic cohort. Data analysis was performed using R Studio version 4.3.2. Results Blood pressure was reported in 120 distinct interactions with older people experiencing homelessness. Compared to the age‐matched NHANES data, older people experiencing unsheltered homelessness were at significantly increased relative risk for elevated blood pressure within the range of Stage 1 Hypertension (RR: 3.914, 95% CI: 2.560–5.892, P < 0.001), and within range of Stage 2 Hypertension (RR: 5.550, 95% CI: 4.272–7.210, P < 0.001). According to NHANES, 49.6% of adults over 60 with diagnosed hypertension receive treatment. Of study participants, 69% of those with elevated blood pressure had previously received a diagnosis of hypertension and 15.9% on medication to control blood pressure. Conclusion Our cohort of older people experiencing unsheltered homelessness had higher rates of elevated blood pressure and reduced rates of hypertension diagnosis and treatment as compared to the general population. Older people experiencing unsheltered homelessness are a growing population, and future research should seek to evaluate and understand older adult care vulnerabilities, including chronic disease management, to improve health outcomes for those who are aging, hypertensive, and unhoused.

INTRODUCTION:Preventative surgical procedures for patients who are breast cancer (BRCA) positive-namely, bilateral salpingo-oophorectomy and mastectomy-have been linked to changes in sexual function, including surgically induced menopause. A patient's decision to undergo preventive surgery as opposed to high-risk screening is heavily reliant on advice received from one's health care provider. Quality of life should be considered when shared decision making is conducted with patients. OBJECTIVES:To assemble and analyze findings related to patient-reported sexual function after these surgical procedures, to see if and how either procedure affects sexual function from patient baseline, and to determine whether the effects can be mitigated with menopausal hormone therapy. METHODS:A literature review based on the PubMed, Embase, and MEDLINE databases was conducted from inception through January 25, 2022. To be included, studies had to meet an a priori list of Medical Subject Headings: "BRCA" AND "sexual dysfunction" OR "dyspareunia." GRADE criteria were used to determine the quality of studies relating to menopause hormone therapy. RESULTS:The search yielded 14 results, and 11 reported sufficient data for systematic review. Sexual function was measured via validated and investigator-generated surveys. All studies, no matter the survey metric, found significant reduction in sexual function with bilateral salpingo-oophorectomy; no studies revealed sexual function changes associated with mastectomy postsurgery. Few studies indicated that menopause hormone therapy resulted in significant improvement in sexual function, and all studies reported that postoperative sexual function could not reach baseline levels with therapy. No studies were high quality by GRADE metrics. CONCLUSION:Prophylactic mastectomies and bilateral salpingo-oophorectomies among patients who are BRCA positive cause SF changes postprocedure. Menopausal hormone therapy offers little help in mediating symptoms. Significantly more research is needed to explore potential changes in sexual function, as it is an important aspect of quality of life for patients with BRCA positivity.

Trauma has substantial effects on human health and is recognised as a potential barrier to seeking or receiving cancer care. The evidence that exists regarding the effect of trauma on seeking cancer screening, diagnosis, and treatment and the gaps therein can define this emerging research area and guide the development of interventions intended to improve the cancer care continuum for trauma survivors. This Review summarises current literature on the effects of trauma history on screening, diagnosis, and treatment among adult patients at risk for or diagnosed with cancer. We discuss a complex relationship between trauma history and seeking cancer-related services, the nature of which is influenced by the necessity of care, perceived or measured health status, and potential triggers associated with the similarity of cancer care to the original trauma. Collaborative scientific investigations by multidisciplinary teams are needed to generate further clinical evidence and develop mitigation strategies to provide trauma-informed cancer care for this patient population.

Abstract Introduction Research suggests that over 60% of women with cancer report sexual functioning difficulties. Cognitive behavioral therapy (CBT) and mindfulness-based interventions (MBIs) have been used to treat sexual functioning difficulties in women with cancer. Objective The purpose of the current systematic review is to examine the state of the science with regard to the clinical efficacy of these interventions and the mechanisms by which they exert their effects. Methods Following PRISMA guidelines, we conducted a systematic review of randomized controlled trials (RCTs), published in English, testing CBT or MBI to improve sexual functioning in women diagnosed with cancer. Articles were identified using PubMed, Scopus, Cochrane, and PsycInfo using keywords and MeSH terms. Two reviewers independently assessed each article for inclusion, with a third to resolve discrepancies. Results Our search resulted in 1,056 articles, nine of which were eligible for inclusion in the review (6 studied CBT, 2 studied MBI, and 1 combined both CBT and MBI techniques). Sample sizes ranged from 21 to 304. One study included an active psychoeducational control group, while the rest were usual care, wait list control, or provided educational materials. Eight focused on breast cancer, and one on gynecologic cancer. All nine studies reported significant improvements in a measure of sexual functioning. Specifically, 8/9 studies found a difference in overall sexual functioning (e.g., Female Sexual Functioning Index (FSFI), PROMIS Sexual Function and Satisfaction Scale, etc.) relative to control. 4/9 studies tested specific domains of the FSFI (arousal, desire, lubrication, orgasm, satisfaction, and pain). Results varied such that relative to controls: 4/4 studies found significant improvement in arousal, 3/4 studies found significant improvement in desire, 3/4 studies found significant improvement in lubrication, 2/4 studies found significant improvement in orgasm, 2/4 studies found significant improvement in satisfaction, and 1/4 studies found significant improvement in pain. The one study that did find improvement in pain employed an MBI for women with breast cancer at any stage. No studies formally tested mechanisms of change. Conclusions Relatively few studies have assessed CBT and MBIs for sexual function in cancer, despite the large body of research on those interventions for cancer supportive care. However, the majority of the 9 CBT/MBI studies demonstrated efficacy for a range of sexual function outcomes. There was little support for improvement in FSFI pain frequency and severity, suggesting more research is needed to develop interventions to target these dimensions of pain. Additionally, given that both CBT and MBIs often work to change pain-related interference, bother, and distress, future studies should take a more in depth approach to pain assessment. Finally, future studies should aim to include active control groups (e.g., attention control) and test for mechanisms of change. Disclosure No

Introduction: Women who undergo breast cancer surgery risk suffering from postsurgical pain long after their surgery. Still, research on postsurgical pain in the subacute phase has been neglected. Objective: This study aims to investigate the incidence, intensity, unpleasantness, and presurgical predictors of acute and subacute postsurgical pain after breast cancer surgery. Methods: The study used an observational design through secondary analyses of the control group in a randomized controlled trial. Data from 102 women undergoing breast cancer surgery were included. Levels of acute and subacute pain intensity and unpleasantness were measured using 100 mm Visual Analogue Scales on the day of surgery and 4 weeks postsurgery. Linear regression analyses were performed to identify presurgical biopsychosocial predictors of acute and subacute postsurgical pain. Results: Average levels of postsurgical pain intensity and unpleasantness were as follows: 22.7 mm for acute pain intensity, 19.0 mm for acute pain unpleasantness, 10.3 mm for subacute pain intensity, and 11.7 mm for subacute pain unpleasantness. Pain expectancy predicted acute pain intensity (R 2 = 0.04, p = 0.047) and acute unpleasantness (R 2 = 0.06, p = 0.02). Perceived social support inversely predicted acute pain unpleasantness (R 2 = 0.04, p = 0.014). Conclusion: Mild and moderate acute pain intensity and unpleasantness are common after breast cancer surgery, whereas levels of subacute pain intensity and unpleasantness are low. Pain expectancy predicts acute postsurgical pain intensity and unpleasantness, whereas expected social support inversely predicts acute postsurgical pain unpleasantness.

The Multi-Professional Oncology Safety and Simulation Training (MOSST) program, supported by the National Cancer Institute was launched in Fall 2018. The original workshop was conducted in person. As the COVID pandemic hit the program was transitioned to an online/distance simulation program using best practices in healthcare simulation design and implementation. The full day workshop was moved to an online platform using Zoom and the in-person simulations were re-developed as video branching case simulations. Learner outcomes that were identical in each modality were evaluated using the evaluation metrics from the original workshop. The use of a distance simulation modality to deliver the MOSST workshop resulted in a high-quality educational experience for the learners and the educational outcomes were comparable to the in-person version. Distance simulation using virtual unfolding case studies and didactic content showed comparable subjective and objective outcomes from participating learners. This work adds to the developing body of research on distance simulation.