Abstract Background Clinician teachers (physicians who teach in clinical settings) experience considerable psychological challenges in providing both educational training and patient care. This study aimed to determine the prevalence of physician burnout and professional fulfillment, and to identify internal and external factors associated with mental health outcomes among Thai clinician teachers working in non-university teaching hospitals. Method A one-time online questionnaire was completed by physicians at 37 governmental, non-university teaching hospitals in Thailand, with 227 respondents being assessed in the main analyses. Four outcomes were evaluated including burnout, professional fulfillment, quality of life, and intentions to quit. Results The observed prevalence of professional fulfillment was 20%, and burnout was 30.7%. Hierarchical regression analysis showed a significant internal, psychological predictor (clinical teaching self-efficacy) and external, structural predictors (multiple roles at work, teaching support), controlling for the background variables of gender, years of teaching experience, family roles, and active chronic disease, with clinical teaching self-efficacy positively predicting professional fulfillment (b = 0.29, p ≤.001) and negatively predicting burnout (b = − 0.21, p =.003). Conclusions Results highlight the importance of faculty development initiatives to enhance clinical teaching self-efficacy and promote mental health among Thai physicians.

Medical simulations allow trainees to work within teams to develop their self-regulated learning (SRL) and socially-shared regulated learning (SSRL) skills (Bransen et al., 2022). Both skillsets help to better prepare medical trainees for the multifaceted challenges inherent in clinical practice. SRL skills are imperative in empowering learners to optimize their performance and become autonomous guiders of their own learning (Jarvela Hadwin, 2013), while SSRL skills are needed to ensure that teams can work collectively to regulate their behaviors and to regulate their own learning to make decisions (Hadwin Oshige, 2011). Questions remain about not only how medical trainees’ behaviors, regulation strategies, and physiological responses vary while they participate in a high-fidelity medical simulation, but how additional data channels to measure human response can provide indicators of teams’ regulation strategies. Using a mixed-methods convergence design incorporating multimodal data (Azevedo Gašević, 2019), including behavioral, SRL and SSRL codes, and electrodermal activity, researchers studied twenty-nine (N = 29) 1st to 3rd year medical residents as they engaged in high-fidelity simulation scenarios. Results suggest that the mean-level of psychophysiological activation increase as simulations progress, in conjunction with an increase in team-regulated learning strategies to manage the effective provision of patient care from initial contact through to the delivery of critical procedures. These results provide valuable insights into the advancement of a team regulation-based framework within a high-fidelity medical simulation environment, leveraging multimodal data to reach an understanding of medical trainees' adoption of team-based approaches to team-regulation during simulation scenarios.

Medical simulation education allows trainees to work together in teams, and to practise assuming the roles of leader and followers, while completing real-world scenarios designed to develop the skills needed to be effective in clinical practice. Despite the importance of residents developing leadership skills to optimize performance and patient outcomes, gaps exist in our understanding of how leadership affects teamwork dynamics, and how leadership skills are observed during crisis resource management (CRM) medical simulation training. Research often frames medical education training from the perspective of self-regulated learning (SRL) and socially shared regulated learning (SSRL) framework, but there is a need to use theory-guided approaches to how SRL and SSRL can be used to teach leadership skills. This study explored how the SRL and SSRL strategies employed by leaders influence teams during CRM medical simulation education scenarios. Eight second-year internal medicine residents were observed as they engaged in two CRM simulations within a high-fidelity medical education simulation environment. The research team observed behaviours, SRL and SSRL strategies, and the leadership and communication skills of the leaders. Behavioural and regulatory coding using the SRL/SSRL group regulation perspective showed that more successful CRM leaders made more frequent use of communication, organizational and group regulation strategies and were thus able to utilize the assets of their team more effectively than leaders who used these skills less frequently. SRL and SSRL are under-examined frameworks in medical and simulation education. Our current case-based analyses illustrate that these frameworks can provide a valuable lens to examine and better understand team behaviours in these contexts. Future work will continue to explore whether the educational applications of SRL/SSRL group regulatory strategies can improve CRM leadership.

Purpose: Oncoplastic breast surgery (OBS) combines breast cancer tumor removal with the cosmetic benefits of plastic surgery at the time of breast-conserving surgery. Potential advantages of OBS include wider surgical margins around the tumor bed, while the natural shape and appearance of the breast are maintained more than standard lumpectomy procedures. However, limited information is available regarding the potential effect on adjuvant radiation treatment planning. Materials and Methods: Women with localized breast cancer undergoing lumpectomy with immediate OBS and adjuvant radiation therapy between 2014 and 2019 were reviewed. OBS was performed using volume displacement techniques and patients received whole-breast irradiation with 3-dimensional conformal radiation therapy. Results: Volume of additional ipsilateral breast tissue removed during OBS ranged from 21 to 2086 cm3 (median, 304 cm3), 29% of patients had >500 cm3 of tissue removed. Surgical margins were positive in 12.5% and were not affected by volume of breast tissue removed (445 vs 439 cm3). Patients with surgical clips more often received a lumpectomy bed boost (75.9% vs 50.0%), boost volumes were on average 157 cm3 with clips versus 205 cm3 without clips. Mean V105 was comparable in patients with >500 cm3 tissue removed and irradiated breast volume >1000 cm3, while higher absolute volumes were found in patients with >26 cm posterior separation (58.0 cm3 vs 102.7 cm3; P = .07). No meaningful difference was observed in Dmax or radiation coverage (95% of the volume receiving 95% of the prescription dose) for patients with >26 cm posterior separation, >500 cm3 of breast tissue removed, or irradiated breast volume >1000 cm3. Conclusions: Radiation dosimetry plans for patients undergoing oncoplastic surgery were acceptable and no significant radiation or surgical advantage was gained in patients with more tissue removed. Our study stresses the importance of clear communication between surgeons and radiation oncologists about sufficient marking of the lumpectomy cavity, using practices that minimize the need for re-excisions and minimize lumpectomy cavity disruption during rearrangement.

BackgroundResearch has suggested that background music can have a positive or negative effect that can influence the affective state of individuals. Although research has demonstrated that fear negatively influences our cognitive performance, there is a research gap in understanding the combined effects of different background music tempo and fear in influencing reading comprehension performance.MethodsData were collected from 70 participants enrolled at a public university in Canada. Participants were required to listen to background music of varying speeds with three conditions (no music, slow music and fast music). We adopted a cross‐sectional multi‐level modelling approach for the main analyses, and further analyses using t‐test and ANOVA.ResultsResults indicated that expression of fear was not a significant predictor of participants' reading comprehension performance (Model 1). However, when music condition was added (Model 2) in addition to expression of fear, a significant relationship between reading comprehension performance and music condition was found, showing better reading comprehension performance in the slow music condition than in the no music condition. Furthermore, there was a significant interaction effect between music condition and expression of fear on reading comprehension performance (Model 3). Importantly, not all individuals were affected by the music to the same extent, with the possibility that baseline level of fear being the key issue in influencing comprehension performance.ConclusionsConsidering both expression of fear and music condition is required to understand the combined effects on cognitive performance. Expression of fear during cognitive tasks such as reading could be an essential signal that interventions should be applied. Such strategies may be especially beneficial for task performers with higher baseline levels of fear and possibly provide us with insights for best practice and research implications in the field of reading comprehension among individuals with special needs.

This present study examines the psycho-emotional and psychophysiological effects that variations in the tempo of background music have on learners who are completing reading comprehension tests while being monitored used multi-modal computer technology. Results of seventy-four ( N = 74) participants indicated that listening to fast tempo music (150 bpm) predicted lower reading comprehension scores, increased emotional expressions of fear, joy and contempt, and higher skin conductance responses (SCRs). Results indicated that participants were more likely to produce higher scores while listening to slow tempo music (110 bpm), but such findings were not connected to significant differences in facial emotion expressions or psychophysiological responses. Contrasting these were control/no-music conditions in which participants exhibited moderated scores. Results from the fast-tempo condition can possibly be attributed in part to an affective valence of emotions and psychophysiological responses, as the multimodal data suggests that a combined regulatory mechanism may be at play while engaged in a learning task. This paper raises several questions regarding the use and effects of background music in performance-based learning settings and the role of affective-stimuli on cognitive regulation.

Esophagectomy is a complex oncologic surgery that results in lower perioperative morbidity and mortality when performed in high-volume hospitals by experienced surgeons; however, limited data exists evaluating the importance of neoadjuvant radiotherapy delivery at high- versus low-volume centers. We sought to compare postoperative toxicity among patients treated with preoperative radiotherapy delivered at an academic medical center (AMC) versus community medical centers (CMC). Consecutive patients undergoing esophagectomy for locally advanced esophageal or gastroesophageal junction (GEJ) cancer at an academic medical center between 2008 and 2018 were reviewed. Associations between patient factors and treatment-related toxicities were calculated in univariate (UVA) and multivariable analyses (MVA). One hundred forty-seven consecutive patients were identified: 89 CMC and 58 AMC. Median follow-up was 30 months (0.33–124 months). Most patients were male (86

This study examined how music major and non-music major participants' performances and emotional expressions differed when exposed to background music of varying tempi while completing a reading comprehension task. Two questions were addressed: (1) What effect does background music of varying tempi have on the performance of music and non-music majors while completing a reading comprehension task? and (2) What real-time expressed emotions and self-report measures may predict the reading comprehension scores between music and non-music majors? A total of 34 participants completed a reading comprehension task under each of three musical test conditions while facial-muscular emotion software analyzed their facial expressions, to understand the effect on performance. Results indicated that music majors displayed significantly different (p < .05) emotional expressions of joy and contempt, which corresponded to no significant differences in performance scores, in comparison to non-majors, whose performance varied greatly across the background music test conditions that were given. These findings support the growing literature surrounding the possible effects of music training and how differences between trained and non-musicians may be understood through emotion detection software.

# 01. Near-peer tutoring: an effective adjunct for virtual anatomy learning {#article-title-2} The start of the COVID-19 pandemic caused a shift in medical education from the classroom to the virtual setting. This abrupt change led to an increase in stress among students. In response, McGill

Background: The Queen Bee phenomenon describes the behavioural response that occurs when women achieve success in a male-dominated environment, and in this position of authority, treat their female subordinates more critically. This behavioural response has been demonstrated in fields such as business, academia, the military, and police force. The goal of this study was to determine whether the Queen Bee phenomenon occurs similarly in surgical specialties within medicine. We hypothesized that female surgeons, fellows, and senior surgical residents would be more critical in their assessment of junior female residents than of their male counterparts. Methods: A scenario-based survey was distributed to all Canadian surgical programs, guised as a survey-based study of patterns of interaction among surgical trainees and staff surgeons. Scenario questions were designed to assess either female or male learners. Respondents’ average Likert score for female-based and male-based questions were calculated. The differences in scores were analyzed. Subgroup analyses were performed based on age, seniority, and surgical specialty. Results: We collected 716 survey responses, with 387 respondents identifying as male (54%) and 321 identifying as female (45%); the remaining 8 respondents did not report gender. This included 385 staff surgeons (54%), 66 fellows (9%), and 263 residents (37%); the remaining 2 respondents did not identify their group. The mean Likert scores for female respond ents assessing female learners was significantly lower than when male learners were assessed ( p = 0.008). During sub-group analysis, resident females scored female learners significantly less favourably than the staff and fellow groups ( p = 0.036). Some subspecialties demonstrated significant scoring differences. Female orthopedic surgeons scored female learners more harshly than male learners ( p = 0.049). Conclusion: The Queen Bee phenomenon was shown

Abstract Purpose Minimally invasive surgery is becoming widely adopted to decrease surgical morbidity and mortality, however data is still evolving and the optimal approach remains an area of controversy. We compared our unique single-institution experience with transhiatal, transthoracic, and minimally invasive approaches to examine survival and toxicity outcomes among patients treated for esophageal cancer. Methods Consecutive patients undergoing esophagectomy for esophageal or gastroesophageal junction (GEJ) cancer at a single institution between 2008 and 2017 were retrospectively reviewed. The patients were stratified by surgical approach. The Kaplan-Meier method was performed using the log-rank test to calculate two-year overall survival (OS) and two-year progression-free survival (PFS). Results A total of 198 consecutive patients were identified: 118 transhiatal esophagectomy (THE), 34 Ivor Lewis esophagectomy (ILE), and 46 minimally invasive esophagectomy (MIE) with a median follow-up of 30.0 months (range, 0.5-136.9 months). Most tumors were adenocarcinoma (89.9%) located in the distal esophagus and GEJ (94%). Neoadjuvant chemoradiotherapy was received by 75.8% of patients. Length of hospitalization, readmission rate, perioperative adverse events, reoperation rates, tracheoesophageal fistula, anastomotic leak, anastomotic stenosis, and 30-day mortality were comparable. Two-year overall survival rates for MIE, THE, and ILE were 71.7%, 67.8%, and 58.8%, respectively (p = 0.003). Progression-free survival at 2 years for MIE, THE, and ILE were 69.6%, 58.5%, and 35.3%, respectively (p = 0.002). Conclusion Minimally invasive esophagectomy is an effective approach which results in comparable perioperative complications and long-term survival outcomes to a transhiatal approach. Minimally invasive esophagectomy can safely be performed and should continue to be studied prospectively.

# 01. The Queen Bee phenomenon in Canadian surgical subspecialties: an evaluation of gender biases in the resident training environment {#article-title-2} The Queen Bee phenomenon describes the behavioural response that occurs when women achieve success in a male-dominated environment, and in this

This paper explores the possibility that knowledge building metadiscourse-discourse about knowledge building-can produce a positive feedback loop, with positive emotional state and knowledge advancement serving to increase each other. Grades 2 and 3 students’ utterances over several months were analyzed as a unit of study, starting with identification of each discourse move and corresponding emotion, defined as a state. These states were then analyzed over time, with a focus on metadiscourse sessions in which students reflected on earlier discourse to identify questions and ideas to be pursued in greater depth. Each discourse move-emotional state was analyzed to determine frequency, transition from one state to another, and spread of each state such as “reflection and positive” and “proposing new directions for inquiry and curiosity.” These two states were among the most frequently occurring in the metadiscourse sessions and virtually absent in other discourse sessions. Transition rates indicated that reflection tended to trigger more reflection, and proposing a new direction led to more proposals for new directions. Sequential pattern analysis suggested sub-sequences specific to metadiscourse sessions. Overall, results indicate that engaging in metadiscourse contributes to students’ productive KB and positive emotions.

Educational video games, with various motivational features and scaffolding support, have high potential for facilitating optimal learning and achievement. However, research on how students utilize game features, identify useful information, and explore solutions to in-game problem scenarios continues to be under-researched. This study aims to unpack the mechanisms underlying users' in-game behaviors to identify emergent markers of optimal problem-solving performance in an educational video game. Survey data and computer logs were collected from 61 participants (36.4% middle and high-school students, Mage = 13; 63.6% university students, Mage = 21) to address the research inquiry of the present study. Results from the regression analysis not only showed an important link between individual characteristics (i.e., self-efficacy, prior knowledge) and success-striving in-game behavior, but also highlighted the role of self-regulated help-seeking behavior in determining students' optimal problem-solving pathways. Our findings add new perspectives to existing research of what learning behaviors are crucial for promoting self-regulation in digital game-based learning. These findings provide useful insight on how to design scaffolding tools in an open-ended problem-solving space to encourage student engagement in effective help-seeking behaviors for optimal learning performance.

Advancements in the fields of education and psychology have continued to develop more complex and nuanced understandings of how emotions function to regulate and modulate human response. In educational psychology, there has been a keen interest in developing the next generation of tools and theoretical imperatives to explore how to best help learners maintain peak emotional and learning performance through the use of adaptive tools. Similarly, advancements in music science have come to explore music as a valuable tool in the modulation of felt and expressed emotion. This literature review examines a cross section of the fields of psychology, music cognition and educational technology to understand how music can modulate emotions and optimizes performance. This review synthesizes relevant literature in these areas and suggests how practitioners and researchers can use advances in musical stimulation to help develop our capabilities for learning theory and performance.

Esophageal cancer patients receiving preoperative radiotherapy had higher rates of postoperative toxicity when radiotherapy was completed at a community medical center versus academic medical center. Explanations for these differences are uncertain but further exploratory analyses regarding dosimetry and radiation field size are warranted.

Advancement in the fields of emotion regulation and performance in learning settings has developed our collective understanding of how affective stimuli modulate emotional responses of learners who are engaging in learning tasks. Studies in the application of background music during cognitively demanding tasks have led to a continued study of how music can be used to affect an emotional response in listeners. The present study used automated facial recognition technology to examine the effects of background music stimulation on middle school learners completing a reading comprehension task. Results indicated that there were significant differences in emotional expressions of anger and frustration while listening to music, coinciding with greater performance on accompanying reading comprehension tasks. The mediation of this 'confused' emotional state could be an indicator of the emotionally salient application of music to help manage these emotional responses. These findings contribute preliminary evidence of the application of facial-emotion recognition technology to identify the effects of musical stimulation on learning, and the possible application of musical stimuli to emotion regulation.