Breaking Down Grit: Persistency and Flexibility in the Career Plans of Military Medical Students.

INTRODUCTION: The field of medicine is experiencing a crisis as high levels of physician and trainee burnout threaten the pipeline of future physicians. Grit, or passion and perseverance for long-term goals, has been studied in high-performing and elite military units and found to be predictive of successful completion of training in adverse conditions. The Uniformed Services University of the Health Sciences (USU) graduates military medical leaders who make up a significant portion of the Military Health System physician workforce. Taken together, an improved understanding of the relationships between burnout, well-being, grit, and retention among USU graduates is critical to the success of the Military Health System. MATERIALS AND METHODS: The current study was approved by the Institutional Review Board at USU and explored these relations among 519 medical students across three graduating classes. These students participated in two surveys approximately one year apart from October 2018 until November 2019. Participants completed measures on grit, burnout, and likelihood of leaving the military. These data were then merged with demographic and academic data (e.g., Medical College Admission Test scores) from the USU Long Term Career Outcome Study. These variables were then analyzed simultaneously using structural equation modeling to examine the relationships among variables in a single model. RESULTS: Results reaffirmed the 2-factor model of grit as both passion and perseverance (or interest consistency). No significant relationships emerged between burnout and other study variables. Sustained and focused interest was predictive of less likelihood of staying in the military. CONCLUSION: This study offers important insights into the relationship among well-being factors, grit, and long-term career planning in the military. The limitations of using a single-item measure of burnout and measuring behavioral intentions in a short time frame during undergraduate medical education highlight the importance of future longitudinal studies that can examine actual behaviors across a career lifespan. However, this study offers some key insights into potential impacts on the retention of military physicians. The findings suggest that military physicians who are most likely to stay in the military tend to embrace a more fluid and flexible medical specialty path. This is critical in expectation setting for the military to train and retain military physicians across a wide range of critical wartime specialties

Well-being at a Military Medical School and Implications for Military Retention.

INTRODUCTION: Physical and psychological well-being play a critical role in the academic and professional development of medical students and can alter the trajectory of a student\u27s quality of personal and professional life. Military medical students, given their dual role as officer and student, experience unique stressors and issues that may play a role in their future intentions to continue military service, as well as practice medicine. As such, this study explores well-being across the 4 years of medical school at Uniformed Services University (USU) and how well-being relates to a student\u27s likelihood to continue serving in the military and practicing medicine. METHODS: In September 2019, 678 USU medical students were invited to complete a survey consisting of three sections-the Medical Student Well-being Index (MSWBI), a single-item burnout measure, and six questions regarding their likelihood of staying in the military and medical practice. Survey responses were analyzed using descriptive statistics, analysis of variance (ANOVA), and contingency table analysis. Additionally, thematic analysis was conducted on open-ended responses included as part of the likelihood questions. RESULTS: Our MSWBI and burnout scores suggest that the overall state of well-being among medical students at USU is comparable to other studies of the medical student population. ANOVA revealed class differences among the four cohorts, highlighted by improved well-being scores as students transitioned from clerkships to their fourth-year curriculum. Fewer clinical students (MS3s and MS4s), compared to pre-clerkship students, indicated a desire to stay in the military. In contrast, a higher percentage of clinical students seemed to reconsider their medical career choice compared to their pre-clerkship student counterparts. Medicine-oriented likelihood questions were associated with four unique MSWBI items, whereas military-oriented likelihood questions were associated with one unique MSWBI item. CONCLUSION: The present study found that the overall state of well-being in USU medical students is satisfactory, but opportunities for improvement exist. Medical student well-being seemed to have a stronger association with medicine-oriented likelihood items than with military-oriented likelihood items. To obtain and refine best practices for strengthening engagement and commitment, future research should examine if and how military and medical contexts converge and diverge throughout training. This may enhance the medical school and training experience and, ultimately, reinforce, or strengthen, the desire and commitment to practice and serve in military medicine

Rheological behavior of hydrophobically modified hydroxyethyl cellulose solutions: A linear viscoelastic model

The rheological behavior of hydrophobically modified hydroxyethyl cellulose HMHEC, an associative thickener, was studied and compared with that of hydrophobically modified ethoxylated urethanes HEURs and nonassociative celluloses. In contrast to HEURs, a simple Maxwell model does not fit the linear viscoelastic behavior of HMHEC. Differences are attributed to the stiffness and comb structure of HMHEC. A generalized Maxwell model with a logarithmic distribution of relaxation times is proposed, and another parameter that includes Rouse-like relaxation is added to fit behavior at high frequencies. Four parameters are needed to describe HMHEC viscoelasticity: a mean relaxation time, lM ; its corresponding standard deviation, s; a plateau modulus, GN ; and a viscosity at infinite frequency, h ` . Satisfactory fitting is obtained for all concentrations and temperatures in the range of frequencies studied. The sharp increase of GN with concentration indicates loop-to-bridge transitions. Temperature does not influence GN , since the reduction in the number density of elastically effective chains caused by Brownian motion masks the direct effect of temperature. The dependence of lM on temperature follows the Arrhenius equation, as does the relaxation time of HEURs, but it does not change with concentration, presumably because the comb structure of HMHEC prevents the formation of long superchains

Supervision of clinical assessment: The Multilevel Assessment Supervision and Training (MAST) approach

Supportive and effective clinical supervision is imperative to the training and development of assessment skills in clinical psychology. This article presents the development of the Multilevel Assessment Supervision and Training approach, a clinic-based method to supervision of assessment. This approach utilizes advanced predoctoral students to serve as peer supervisors for beginning predoctoral trainees conducting psychoeducational assessments. It offers several advantages, providing a peer mentoring supervisory experience during graduate education, improving the training experience and oversight for beginning trainees, and improving service delivery. Satisfaction ratings were collected from graduate trainees and their peer supervisors who support the utility of this approach

Profiles of Military Medical Students\u27 Well-being, Burnout, and Retention

BACKGROUND: Well-being concerns among medical students are more prevalent than their age-matched peers in the United States. It remains unknown, however, if individual differences in well-being exist among U.S. medical students serving in the military. In this study, we sought to identify profiles (i.e., subgroups) of well-being in military medical students and examine the associations between these well-being profiles and burnout, depression, and intended retention in military and medical fields. METHODS: Using a cross-sectional research design, we surveyed military medical students and then conducted latent class analysis to explore profiles of well-being, and applied the three-step latent class analysis method to assess predictors and outcomes of well-being profiles. RESULTS: Heterogeneity in well-being was identified among the 336 military medical students surveyed, portraying medical students\u27 falling into three distinct subgroups: High well-being (36%), low well-being (20%), and moderate well-being (44%). Different subgroups were associated with different risks of outcomes. Students in the subgroup of low well-being were at the highest risk of burnout, depression, and leaving medicine. In contrast, students in the moderate well-being group were at the highest risk of leaving military service. CONCLUSIONS: These subgroups may be clinically important as burnout, depression, and intention to leave medical field and/or military service occurred with varying likelihoods among medical students across the different well-being subgroups. Military medical institutions may consider improving recruitment tools to identify the best alignment between students\u27 career goals and the military setting. Besides, it is crucial for the institution to address diversity, equity, and inclusion issues that may lead to alienation, anxiety, and a sense of wanting to leave the military community

Migration Timing and Wintering Areas of Three Species of Flycatchers (Tyrannus) Breeding in the Great Plains of North America

Descriptions of intra- and interspecific variation in migratory patterns of closely related species are rare yet valuable because they can help assess how differences in ecology and life-history strategies drive the evolution of migration. We report data on timing and location of migration routes and wintering areas, and on migratory speed and phenology, of Eastern Kingbirds (Tyrannus tyrannus) from Nebraska and Oklahoma and of Western Kingbirds (T. verticalis) and Scissor-tailed Flycatchers (T. forficatus) from Oklahoma. Eastern Kingbirds primarily departed the breeding site in September, migrating to the Amazon Basin (Bolivia and Brazil), \u3e6,400 km from their breeding site, then used a second wintering site in northwestern South America (Colombia, Ecuador, and Peru) before returning to the breeding site in April. Western Kingbirds left Oklahoma in late July, migrating \u3e1,400 km to northwestern Mexico, then to central Mexico and finally to Central America before returning to Oklahoma in April. Scissor-tailed Flycatchers departed Oklahoma mainly in mid-October, migrating to Central America (El Salvador, Guatemala, Honduras, and Nicaragua), ~2,600 km from the breeding site, remaining there until early April before returning to Oklahoma. Timing of migration appears to be tightly linked to molt. Early departure of Western Kingbirds from the breeding site appears to be timed so that they molt in the Sonoran Desert region during the monsoon, whereas Scissor-tailed Flycatchers remain at their breeding site to complete molt in late summer, when insect prey are abundant. Eastern Kingbirds delay molt until reaching South America where, possibly, abundant fruit supports molt