Perfectionism, Power, and Process: What We Must Address to Dismantle Mental Health Stigma in Medical Education

In this commentary, the authors draw on 2 personal accounts of mental illness published by Kirk J. Brower, MD, and Darrell G. Kirch, MD, in this issue to consider how and why mental health stigma is maintained in medical education. In particular, they explore how perfectionism, power differentials, and structural forces drive mental illness stigma in medical education. They argue that mental health stigma in medical education, while deeply embedded in the physician archetype and medical culture, is not inevitable and that dismantling it will require individual courage, interpersonal acceptance, and institutional action

A Randomized Trial of a Multimodal Community-Based Prisoner Reentry Program Emphasizing Substance Abuse Treatment

Prisoner reentry programs continue to be developed and implemented to ease the process of transition into the community and to curtail fiscal pressures. This study describes and provides relapse and recidivism outcome findings related to a randomized trial evaluating a multimodal, community-based reentry program that prioritized substance abuse treatment. Results from analyses suggest negligible effects for participants of the program across multiple outcome indicators. Avenues for further exploration are provided, with a cautionary emphasis on the continued expansion of multimodal community-based reentry programs

Alternative models of instant drug testing: evidence from an experimental trial

Objective This study describes and provides relapse and recidivism outcome findings related to an experimental trial evaluating the viability of frequent, random drug testing with consequences for use. Methods The sample consisted of 529 offenders released on parole. An experimental design with random assignment to one of three groups was employed. The Experimental Group received frequent, random drug testing with instant results, immediate sanctions, and referral for substance abuse treatment. Control Group I received frequent, random drug testing and treatment referral, but did not receive immediate test results or immediate sanctions. Control Group II followed standard parole practice. Members of this group were not tested on a random basis and did not receive immediate sanctions. Repeated measures ANOVA and survival analysis techniques were used to explore group differences. Results Frequent monitoring of drug use with randomized testing protocols, immediate feedback, and certain consequences is effective in lowering rates of relapse and recidivism. The effectiveness is particularly salient in the short term during the period of exposure to testing conditions. Conclusions The findings lend support to the use of randomized testing with swift and certain sanctions with parolees. Additional quality evidence is necessary to generalize and refine findings from this study and others that focus on sanction certainty. Future replications must consider the immediacy of test result and sanction execution as well as the length of exposure to randomized testing periods

When will I get my paper back? A replication study of publication timelines for health professions education research.

INTRODUCTION: Biomedical researchers have lamented the lengthy timelines from manuscript submission to publication and highlighted potential detrimental effects on scientific progress and scientists\u27 careers. In 2015, Himmelstein identified the mean time from manuscript submission to acceptance in biomedicine as approximately 100 days. The length of publication timelines in health professions education (HPE) is currently unknown. METHODS: This study replicates Himmelstein\u27s work with a sample of 14 HPE journals published between 2008-2018. Using PubMed, 19,182 article citations were retrieved. Open metadata for each were downloaded, including the date the article was received by the journal, date the authors resubmitted revisions, date the journal accepted the article, and date of entry into PubMed. Journals without publication history metadata were excluded. RESULTS: Publication history data were available for 55% (n = 8) of the journals sampled. The publication histories of 4,735 (25%) articles were analyzed. Mean time from: (1) author submission to journal acceptance was 180.93 days (SD = 103.89), (2) author submission to posting on PubMed was 263.55 days (SD = 157.61), and (3) journal acceptance to posting on PubMed was 83.15 days (SD = 135.72). DISCUSSION: This study presents publication metadata for journals that openly provide it-a first step towards understanding publication timelines in HPE. Findings confirm the replicability of the original study, and the limited data suggest that, in comparison to biomedical scientists broadly, medical educators may experience longer wait times for article acceptance and publication. Reasons for these delays are currently unknown and deserve further study; such work would be facilitated by increased public access to journal metadata

Collaborative Development of Clinical Trials Education Programs for African-American Community-Based Organizations

This paper describes the use of a unique ”Learning and Feedback” approach to tailor cancer clinical trials education programs for Community Bridges, a peer training intervention designed for African American communities in North Carolina. Generic community education modules were demonstrated with key community leaders who were designated as trainers. Quantitative and qualitative assessments were provided on understanding of content, comfort with material and cultural relevance. The generic materials were adapted into three revised modules, all featuring key messages about cancer clinical trials, discussion regarding distrust of medical research, common misconceptions about trials, patient protections, and a call to action to prompt increased inquiry about locally available trials. The revised modules were then used as part of a train-the-trainer program with 12 African American community leaders. ENACCT’s use of the Learning and Feedback process is an innovative method for culturally adapting clinical trials education

'To live and die [for] Dixie': Irish civilians and the Confederate States of America

Around 20,000 Irishmen served in the Confederate army in the Civil War. As a result, they left behind, in various Southern towns and cities, large numbers of friends, family, and community leaders. As with native-born Confederates, Irish civilian support was crucial to Irish participation in the Confederate military effort. Also, Irish civilians served in various supporting roles: in factories and hospitals, on railroads and diplomatic missions, and as boosters for the cause. They also, however, suffered in bombardments, sieges, and the blockade. Usually poorer than their native neighbours, they could not afford to become 'refugees' and move away from the centres of conflict. This essay, based on research from manuscript collections, contemporary newspapers, British Consular records, and Federal military records, will examine the role of Irish civilians in the Confederacy, and assess the role this activity had on their integration into Southern communities. It will also look at Irish civilians in the defeat of the Confederacy, particularly when they came under Union occupation. Initial research shows that Irish civilians were not as upset as other whites in the South about Union victory. They welcomed a return to normalcy, and often 'collaborated' with Union authorities. Also, Irish desertion rates in the Confederate army were particularly high, and I will attempt to gauge whether Irish civilians played a role in this. All of the research in this paper will thus be put in the context of the Drew Gilpin Faust/Gary Gallagher debate on the influence of the Confederate homefront on military performance. By studying the Irish civilian experience one can assess how strong the Confederate national experiment was. Was it a nation without a nationalism