Background: The association of physical restraint (PR) use in hospitalized adults with a history of child abuse or neglect (CON) is underexplored. Objective: To determine whether PRs were associated with worse hospital outcomes among adults with prior experience of CON. Participants and Setting: Using the 2022 National Inpatient Sample, we identified adults with a history of CON and compared those with and without PRs. Methods Multivariable regression analyses assessed in-hospital mortality, length of stay (LOS), total hospital charges, and discharge disposition. Results 74,640 adults with a history of CON were hospitalized. Among them, 1,725 (2.3%) had PRs. Physically restrained and unrestrained patients were of comparable ages (mean age 36.5 vs. 35.5 years, p = 0.16). A greater proportion of males and Blacks were restrained rather than unrestrained (46.1% vs. 35.6%; p < 0.01) and (24.6% vs. 16.4%; p < 0.01), respectively. Mortality was non-significantly higher in the PR group (adjusted Odds Ratio {aOR}=1.4, Confidence Interval {CI}: [0.3–6.9]; p = 0.63). Significantly longer LOS (adjusted Mean Difference {aMD} = +3.8 days, CI: [2.1–5.8]; p < 0.01) and higher hospital charges were observed for PR patients ({aMD} = +$19,211, CI: [8,329 − 30,093]; p < 0.01). PR patients had a lower adjusted odds of being discharged home compared to unrestrained patients ({aOR} = 0.57, CI: [0.41–0.78]; p < 0.01). Conclusion Adults with a history of CON and PRs during hospitalization had inferior in-hospital resource utilization outcomes compared to the unrestrained. Interventions aimed at limiting PR use in this patient population should be the goal for care.

OBJECTIVE:Acute severe asthma (ASA) is associated with a heightened risk of death. The influence of ambient temperature on in-hospital mortality and healthcare utilization for patients with ASA is poorly characterized. METHODS:Using the National Inpatient Sample, we compared adults hospitalized with ASA in the northeast with southern regions of the United States. We used multivariable regression to determine outcomes (mortality, length of stay, hospital charges, and discharge site after hospitalization). We coupled ambient temperature data for regional comparisons using the National Centers for Environmental Information. RESULTS:From 2016 to 2019, 5485 patients were admitted with ASA; 2050 (37.4%) were in the Northeast, and 3435 (62.6%) were in the South. Comparison groups had similar mean ages, gender distribution, and comorbidity burden (all P values >0.05). No significant differences with respect to adjusted odds ratio (aOR) of mortality (aOR 0.65, 95% confidence interval [CI] 0.2-2.1, P=0.48) or adjusted mean difference (aMD) in length of stay (aMD 0.82 days, 95% CI -0.0 to 1.6, P=0.05) were observed. Patients in the Northeast had higher hospital charges (aMD $20,986, 95% CI 6743-35,228, P=0.04) and lower odds of being discharged to home (aOR 0.65, 95% CI 0.44-0.97, P=0.03), however. Throughout all months across the 4-year study period, average monthly temperatures were lower in the Northeast compared with the South. CONCLUSIONS:Patients with ASA in the cooler Northeast incurred greater hospital charges and were less likely to be discharged home after hospitalizations than in the South. Future interventions to improve outcome differences may consider ambient temperature factors.

In this article, we examine the differences in charitable donating behaviors among three groups: a nationally representative American sample (N = 513), individuals with an annual household income greater than $250,000 (N = 253), and individuals with significant illness (heart disease or cancer; N = 516). We then use a validated donor motivations scale to examine whether these groups' reasons for donating money to nonprofits differ. While the extant literature provides information on who is likely to give and under what contexts, it treats donors as a homogenous group, only differentiating them by certain demographic variables. The current study examines two different groups based on two fundamental attributes: wealth and health. We hypothesized that systematic differences in giving behavior and self-reported motivations exist across these groups compared to a nationally representative sample. Instead, we found that only high-income individuals differed in their giving behaviors and motivations. These results show that donor behavior and motivations may depend on their wealth. This research may help fundraisers and development professionals better understand how and why different prospects donate.

It is known that transgender people experience health inequalities. Disparities in hospital outcomes impacting transgender individuals have been inadequately explored. We conducted this retrospective cohort study using the National Inpatient Sample (01/2018-12/2019) to compare in-hospital mortality and utilization variables between cisgender and transgender individuals using regression analyses. Approximately two-thirds of hospitalizations for transgender patients (n = 10,245) were for psychiatric diagnoses. Compared to cisgender patients, there were no significant differences in adjusted means differences (aMD) in length of stay (LOS) (aMD = -0.29; p = .16) or total charges (aMD = -$486; p = .56). An additional 4870 transgender patients were admitted for medical diagnoses. Transgender and cisgender individuals had similar adjusted odds ratios (aOR) for in-hospital mortality (aOR = 0.96; p = .88) and total hospital charges (aMD = -$3118; p = .21). However, transgender individuals had longer LOS (aMD = +0.46 days; confidence interval [CI]: 0.15-0.90; p = .04). When comparing mortality and resource utilization between cisgender and transgender individuals, differences were negligible.

Although primary care is associated with population health benefits, the supply of primary care physicians continues to decline. Internal medicine (IM) primary care residency programs have produced graduates that pursue primary care; however, it is uncertain what characteristics and training factors most affect primary care career choice. To assess factors that influenced IM primary care residents to pursue a career in primary care versus a non-primary care career. Multi-institutional cross-sectional study. IM primary care residency graduates from seven residency programs from 2014 to 2019. Descriptive analyses of respondent characteristics, residency training experiences, and graduate outcomes were performed. Bivariate logistic regression analyses were used to assess associations between primary care career choice with both graduate characteristics and training experiences. There were 256/314 (82

OBJECTIVES:Evidence has shown that lesbian, gay, bisexual, queer (LGBQ) and transgender patients (LGBTQ) experience disparities in health care delivery and clinical outcomes. As the predominant U.S. inpatient provider workforce, this paper's objective was to understand hospitalists' comfort with LGBTQ health. METHODS:A 58-question anonymous online survey was distributed in 2019 to practicing hospitalists through the Society of Hospital Medicine regarding their experiences in caring for hospitalized LGBTQ patients. RESULTS:Two hundred and eighteen hospitalist providers completed the entire survey. While hospitalists reported high levels of comfort in caring for these populations (LGBQ: 90.6%, Transgender: 77.8%), they acknowledged feeling less confident in their clinical competence (LGBQ: 71.6%, Transgender: 51.2%). Hospitalist providers who were themselves LGBQ reported more comfort with most aspects of LGBQ patient clinical care than heterosexual respondents (p < 0.05 for 4 of 6 comfort variables). Seventy-four percent of hospitalists wanted training to advance their knowledge and skills in working with LGBTQ patients. CONCLUSIONS:Hospitalist clinicians are regularly exposed to LGBTQ patients yet their comfort and expertise in caring for this vulnerable population is highly variable. Educational interventions that include reflective practice may serve to optimize hospitalists' ability to more confidently and competently serve LGBTQ patients.

Background Impostor phenomenon (IP) describes feelings of inadequacy often experienced by individuals struggling to internalize success despite evidence to the contrary. IP is common in medicine and can be experienced as a cycle following exposure to an achievement-focused task, leading to fear of being found out as an impostor. Prior research describes IP characteristics, yet few studies have identified factors that mitigate IP among medical residents. Objective To understand factors that moderate IP among internal medicine (IM) residents. Methods We conducted a qualitative study using one-on-one semistructured interviews with 28 IM residents at a single academic health center from May to June 2020. To ascertain the prevalence of IP, informants completed a 20-item Clance Impostor Phenomenon Scale (CIPS) questionnaire. Using a constructivist thematic approach investigators independently coded transcripts to identify factors mitigating IP. Results Twenty-eight of 53 (53%) eligible residents participated in the study. Most informants were female (21 of 28, 75%) and in their second postgraduate year of training (12 of 28, 43%). The mean CIPS score was 63. When faced with an achievement-focused task, informants describe feelings of inadequacy, avoidance behaviors, distortion of feedback, and attribution beliefs. Internal factors found to moderate IP include (1) reframing attribution beliefs; (2) accepting feedback; and (3) acknowledging strengths. External factors include (1) mentors, coaches, and role models; (2) formal opportunities to share IP experiences; and (3) growth-oriented learning environments. Conclusions This qualitative study describes internal and external factors that potentially mitigate impostor feelings, thereby interrupting the cyclical nature of IP among IM residents.

INTRODUCTION:Imposter phenomenon is common among medical trainees and may influence learning and professional development. The authors sought to describe imposter phenomenon among internal medicine residents.METHODS:In 2020, using emailed invites we recruited a convenience sample of 28 internal medicine residents from a teaching hospital in Baltimore, Maryland to participate in an exploratory qualitative study. In one-on-one interviews, informants described experiences of imposter phenomenon during residency training. Using thematic analysis to identify meaningful segments of text, the authors developed a coding framework and iteratively identified and refined themes. Informants completed the Clance Imposter Phenomenon Scale.RESULTS:Informants described feelings and thoughts related to imposter phenomenon, the contexts in which they developed and the impact on learning. Imposter phenomenon has profound effects on residents including: powerful and persistent feelings of inadequacy and habitual comparisons with others. Distinct contexts shaping imposter phenomenon included: changing roles with increasing responsibilities; constant scrutiny; and rigid medical hierarchy. Learning was impacted by inappropriate expectations, difficulty processing feedback, and mental energy diverted to impression management.DISCUSSION:Internal medicine residents routinely experience imposter phenomenon; these feelings distort residents' sense of self confidence and competence and may impact learning. Modifiable aspects of the clinical learning environment exacerbate imposter phenomenon and thus can be acted upon to mitigate imposter phenomenon and promote learning among medical trainees.

Background Residency is an important time for career planning. Little is known about how trainees make career decisions during this formative period. Objective The objective of this study was to understand whether 'design thinking' activities help to inform Internal Medicine-Paediatrics (Med-Peds) residents' career decisions. Methods We performed a cross-sectional survey of a national sample of fourth-year Med-Peds residents in May-July 2019 covering intended career, helpfulness of 'life design' strategies used to inform career decision and confidence with intended career plans. Bivariate analyses were performed to evaluate associations between used strategies and confidence with career plans. Results A total of 86/145 (59%) of residents responded to the survey. The most helpful activities for clarifying career decisions were immersive exposure to the career during residency, and reflecting on compatibility of careers with their views of life and work. Finding the right mentor was associated with higher confidence in one's intended career path (p<0.05). There were no significant differences with confidence in intended career plan by gender or career path. Career decisions made during the first 2 years of residency were associated with higher confidence than those made prior to or in the second half of residency (p=0.01 and p=0.004). Conclusion This national survey of graduating Med-Peds residents reveals that proactive life design strategies were helpful in bringing clarity to their decision and were associated with higher confidence in intended career plans. These data should be of interest to residency training programmes in their efforts to support trainees with their career decisions.

Background Hospitalist turnover is exceedingly high, placing financial burdens on hospital medicine groups (HMGs). Following training, many begin their employment in medicine as early-career hospitalists, the majority being millennials. Objective To understand what elements influence millennial hospitalists' recruitment and retention. Design We developed a survey that asked participants to rate the level of importance of 18 elements (4-point Likert scale) in their decision to choose or remain at an HMG. Participants The survey was electronically distributed to hospitalists born in or after 1982 across 7 HMGs in the USA. Main Measures Elements were grouped into four major categories: culture of practice, work-life balance, financial considerations, and career advancement. We calculated the means for all 18 elements reported as important across the sample. We then calculated means by averaging elements within each category. We used unpaired t-tests to compare differences in means for categories for choosing vs. remaining at an HMG. Key Results One hundred forty-four of 235 hospitalists (61%) responded to the survey. 49.6% were females. Culture of practice category was the most frequently rated as important for choosing (mean 96%, SD 12%) and remaining (mean 96%, SD 13%) at an HMG. The category least frequently rated as important for both choosing (mean 69%, SD 35%) and remaining (mean 76%, SD 32%) at an HMG was career advancement. There were no significant differences between respondent gender, race, or parental status and ratings of elements for choosing or remaining with HMGs. Conclusion Culture of practice at an HMG may be highly important in influencing millennial hospitalists' decision to choose and stay at an HMG. HMGs can implement strategies to create a millennial-friendly culture which may help improve recruitment and retention.

Advanced practice providers (APPs) graduate from school with variable hospitalist experience. While hospitalist-specific onboarding is recommended for hospitalist APPs, no standard method currently exists to assess their readiness for practice. We created a 17-item instrument called the Cardin Hospitalist Advanced Practice Provider-Readiness Assessment (CHAPP-RA) to assess APPs'; readiness for practice using a milestones-based scale. We piloted CHAPP-RA at a single site where 11 APPs with varied experience were rated by 30 supervising physicians. Supervisors also provided global ratings for overall performance. We investigated the feasibility of CHAPP-RA and collected validity evidence for the interpretation of scores. The mean time to complete one CHAPP-RA was 10.5 min. Supervisors rated novice APPs lower than more experienced APPs, p <= .001. CHAPP-RA ratings also correlated strongly with global ratings. CHAPP-RA is feasible to implement and has initial validity evidence.

Background High-quality goals of care (GOC) communication is fundamental to providing excellent critical care. Objective Educate medical intensive care unit (MICU) clinicians, design and implement workflows relating to GOC communication, and measure the impact on communication proficiency and rate of GOC documentation. Methods Guided by Lean Six Sigma principles, an interprofessional team from palliative and critical care tailored a multicomponent intervention—the 3-Act Model communication training and workflow modification—to equip and empower the pulmonary and critical care medicine (PCCM) fellow as the clinical lead for GOC discussions. Fellows’ education included in-person narrative reflection, asynchronous online didactic and demonstration videos of the 3-Act Model, online roleplays, and direct observation leading GOC discussions in the ICU. PCCM fellows were objectively evaluated for proficiency using the Goals of Care Assessment Tool. To evaluate the impact of our intervention on documented GOC conversations, we performed a retrospective chart review over two 3-month periods (before and after intervention) when the MICU cared exclusively for critically ill patients with coronavirus disease (COVID-19). Results All PCCM fellows demonstrated proficiency in GOC communication via online simulated roleplays, as well as in observed bedside GOC communication. Per chart review of patients with a minimum of 7 consecutive days in the MICU, documented GOC conversations were found for 5.55% (2/36) of patients during the preintervention period and for 28.89% (13/45) of patients in the postintervention period. Palliative care consults increased in the pre- versus postintervention period: for all patients, 4.85% versus 14.52% (P < 0.05); for patients age ⩾80 years, 3.54% versus 29.41% (P < 0.05); and for patients with MICU length of stay ⩾7 days, 2.78% versus 24.44% (P < 0.05). Conclusion Combining 3-Act Model education for PCCM fellows with Lean Six Sigma quality improvement resulted in effective GOC communication training and improved palliative care integration in the ICU.

Introduction: Podcasts have become popular among medical trainees. However, it is unclear how well learners retain information from podcasts compared to traditional educational modalities, and whether multitasking affects the learner's ability to pay attention and learn. This study attempted to examine the effectiveness of podcast learning by using electroencephalography (EEG) to measure learner attention, in addition to test performance, task load, and preferences. Methods: The study used a repeated measures design with three conditions: podcast listening on a treadmill, podcast listening seated, and textbook reading seated. Participants were anesthesiology residents and medical students at a large United States academic medical center. Three topics were chosen: allergic response, liver physiology, and statistics. Each participant studied all three topics that were randomly assigned to one of three learning conditions - in random order. Participants completed a knowledge test at baseline, after each condition, and at four-week follow-up, and reported preferred learning modality and task load under each modality. Activation levels in alerting, orienting, and executive attentional networks were examined using EEG. Results: Sixty-one participants (11 anesthesiology residents and 50 medical students) were included in the study. Of the 61, six were excluded from the EEG analyses due to corrupted recordings. EEG results showed that mean attention network activation scores did not differ between the study conditions. Trainees preferred podcast learning over reading for all three topics. When compared to textbook reading, podcast learning (seated or on a treadmill) produced significantly better learning gain, and equivalent retention for two of the three topics. Conclusions: Our study is the first to use neurocognitive data, self-reported satisfaction, and knowledge test performance to demonstrate that podcasts are at least equivalent to textbooks for maintaining attention, immediate learning, and retention - even while exercising.

STUDY PURPOSE:Distrust of the healthcare system is longstanding in the black community. This may especially threaten the health of the population when a highly contagious infection strikes. This study aims to compare COVID-19-related perspectives and behaviours between hospitalised black patients who trust versus distrust doctors and healthcare systems.STUDY DESIGN:Cross-sectional study at a tertiary care academic hospital in Baltimore, Maryland. Hospitalised adult black patients without a history of COVID-19 infection were surveyed between November 2020 and March 2021 using an instrument that assessed COVID-19-related matters. Analyses compared those who trusted versus mistrusted doctors and healthcare systems.RESULTS:37 distrusting hospitalised black patients were compared with 103 black patients who trusted doctors and healthcare systems. Groups had similar sociodemographics (all p>0.05). Distrustful patients were less likely to think that they were at high risk of contracting COVID-19 (54.0% vs 75.7%; p=0.05), less likely to believe that people with underlying medical conditions were at higher risk of dying from the virus (86.4% vs 98.0%; p=0.01) and less likely to be willing to accept COVID-19 vaccination (when available) (51.3% vs 77.6%; p<0.01) compared with those who were trusting.CONCLUSION:Healthcare distrustful hospitalised black patients were doubtful of COVID-19 risk and hesitant about vaccination. Hospitalisations are concentrated exposures to the people and processes within healthcare systems; at these times, seizing the opportunity to establish meaningful relationships with patients may serve to gain their trust.