Development and validation of a 6-plex Luminex-based assay for measuring human serum antibodies to group B streptococcus capsular polysaccharides

Six serotypes (Ia, Ib, II, III, IV, and V) cause nearly all group B streptococcal (GBS) disease globally. Capsular polysaccharide (CPS) conjugate vaccines aim to prevent GBS disease, however, licensure of a vaccine would depend on a standardized serological assay for measuring anti-CPS IgG responses. A multiplex direct Luminex-based immunoassay (dLIA) has been developed to simultaneously measure the concentration of serum IgG specific for the six prevalent GBS CPS serotypes. Assay validation was performed using serum samples obtained from human subjects vaccinated with an investigational 6-valent GBS CPS conjugate vaccine. Results for the assay are expressed as IgG concentrations (µg/mL) using a human serum reference standard composed of pooled sera from vaccinated subjects. The lower limits of quantitation (LLOQ) for all serotypes covered in the 6-plex GBS IgG dLIA fell within the range of 0.002-0.022 µg/mL IgG. Taken together, the 6-plex GBS IgG dLIA platform is specific for the six GBS serotypes included in Pfizer's investigational vaccine, has a wide dilution adjusted assay range, and is precise (<18.5% relative standard deviation) for all serotypes, and, therefore, is suitable for quantitatively measuring vaccine-induced or naturally acquired serotype-specific anti-CPS IgG responses against GBS.

Program Directors' Perspectives on Residency Applications in the Post‒United States Medical Licensing Examination Step 1 Era: A Case for Standardized Letters of Recommendation?

INTRODUCTION

The United States Medical Licensing Examination (USMLE) Step 1 test evolved into a key metric utilized by program directors (PDs) in assessing candidates for residency. The transition to a USMLE Step 1 binary pass/fail scoring system has resulted in a loss of an important objective assessment. With national movements toward pass/fail systems for clerkship grading and trends toward abandonment of class ranking, assessing residency applications has become increasingly challenging.

METHODS

The Society of Academic Urologists convened a task force to, in part, assess the perspectives of urology PDs regarding the importance of various aspects of a residency application for predicting clinical performance. An anonymous survey was disseminated to all urology PDs in the US. Perspectives on 11 potential application predictors of clinical performance and demographics were recorded. Descriptive statistics characterized PD responses. Friedman test and pairwise Wilcoxon tests were used to evaluate the relative ranks assigned to application elements by PDs.

RESULTS

There was a 60.5% response rate (89/147). Letters of recommendation (LORs) were ranked as the most important predictor, with a mean rank of 2.39, median of 2 (IQR 1-3). Clerkship grades and USMLE Step 1 were comparable and ranked second. Medical school reputation ranked the lowest. There was significant subjective heterogeneity among categories; however, this was less so for LORs, which predominated as the most important factor among application elements (P < .001).

CONCLUSIONS

To our knowledge, this is the largest sample size assessing PD perspectives on application factors that predict clinical performance. The second (clerkship grades) and third (USLME Step 1) most important factors moving toward binary pass/fail systems create an opportunity for actionable change to improve assessment objectivity. Our data demonstrate LORs to be the most important factor of residency applications, making a compelling argument for moving toward a standardized LOR to maximize this tool, mitigate bias, and improve interreviewer reliability.

Synthetic cannabinoids in hair-Prevalence of use in abstinence control programs for driver's license regranting in Germany

Although the use, structural variety, and prevalence of synthetic cannabinoids (SCs) have steadily increased on the drug market, they are rarely analyzed in abstinence control programs for driver's license regranting. The aim of this study was to determine the SC prevalence in these programs by analyzing hair samples collected between March 2020 and March 2021 from various regions in Germany, mainly Bavaria (40%). Specimens were analyzed quantitatively for drugs of abuse and qualitatively for 107 SCs. Hair samples were screened by liquid chromatography-tandem mass spectrometry (LC-MS/MS), and to search for unknown SC analogs, positive samples were additionally screened by liquid chromatography-high resolution time of flight mass spectrometry (LC-qTOF/MS). The analysis of 5097 hair samples resulted in 181 SC detections (3.6%), showing a wide range of 44 SCs, with up to 13 different compounds found in a single sample. The most prevalent compounds were 5F-MDMB-PICA and MDMB-4en-PINACA; furthermore, 10 new substances not initially covered by LC-MS/MS analysis were detected by LC-qTOF/MS. The SC positivity rate was comparable to cocaine (5.4%) and amphetamine (2.6%). Only in 35 cases (0.7%), SC analysis was requested by the clients, highlighting the insufficient coverage of SC consumption in the studied collective. In summary, hair sample analysis proved to be a valuable tool to monitor the use of SCs. In order to keep pace with newly emerging SC analogs, an up-to-date analytical method is essential. Prospectively, SCs should be more routinely screened in hair analysis for abstinence control to avoid cannabis substitution by SCs.

Social processes influencing nursing students in passing the nursing licensure examination: A grounded theory approach

AIM

To explore the strategies used by nursing students in passing the nursing licensure examination.

DESIGN

This study uses a classic grounded theory design to explore the social processes influencing a nursing license examination.

METHODS

Eight graduate students participated in this research study and were interviewed in-depth twice. The Classic Grounded Theory method of Glaser was applied to collect and analyse the data until saturation was reached.

RESULTS

The findings revealed that students who passed the nursing licensure examination described the strategies as a preliminary model comprising a core category, Reviewing (Phase 1), which consisted of two sub-categories: Entering Time and Reviewing Styles. Additionally, two other main categories emerged: the Tutoring category (Phase 2) and the Testing Practice category (Phase 3). It was observed that each course (subject) does not necessarily follow a specific order in traversing these phases; they may move back and forth between them until the conclusion of the examination. Furthermore, it was found that the time allocated to Entering Time and completing the three phases significantly influences the successful passing of the nursing licensure examination.

Novice driver crashes: The relation between putative causal factors, countermeasures, real world implementations, and policy - A case study in simple, scalable solutions

Novice drivers are at a greatly inflated risk of crashing. This led in the 20th century to numerous attempts to develop training programs that could reduce their crash risk. Yet, none proved effective. Novice drivers were largely considered careless, not clueless. This article is a case study in the United States of how a better understanding of the causes of novice driver crashes led to training countermeasures targeting teen driving behaviors with known associations with crashes. These effects on behaviors were large enough and long-lasting enough to convince insurance companies to develop training programs that they offered around the country to teen drivers. The success of the training programs at reducing the frequency of behaviors linked to crashes also led to several large-scale evaluations of the effect of the training programs on actual crashes. A reduction in crashes was observed. The cumulative effect has now led to state driver licensing agencies considering as a matter of policy both to include items testing the behaviors linked to crashes on licensing exams and to require training on safety critical behaviors. The effort has been ongoing for over a quarter century and is continuing. The case study highlights the critical elements that made it possible to move from a paradigm shift in the understanding of crash causes to the development and evaluation of crash countermeasures, to the implementation of those crash countermeasures, and to subsequent policy changes at the state and federal level. Key among these elements is the development of simple, scalable solutions.

Evolving Licensure Examination: Assessing Student Confidence and Accuracy With Next Generation NCLEX

BACKGROUND

The Next Generation NCLEX (NGN) includes new item types. Little is known about nursing students' confidence and accuracy in answering these questions.

METHOD

A descriptive comparative study examined prelicensure nursing students' confidence and accuracy in answering NGN-style items versus multiple-choice questions (MCQs) of the same content via a 12-item quiz.

RESULTS

Less than one third of students (n = 194; 32.1%) reported feeling confident in answering NGN questions. Students' confidence levels had no relationship on scores with NGN items. When comparing NGN-style items to MCQs, students' (n = 221) scores on NGN-style items were lower with bowtie or a select-all-that-apply questions but higher with highlight table or matrix multiple-choice questions.

CONCLUSION

Students' lack of confidence with certain item types suggests faculty should incorporate these item types into classroom activities or course assignments. NGN test-taking strategies also should be incorporated and frequently reinforced throughout the curriculum. [J Nurs Educ. 2024;63(4):252-255.].

Capability of GPT-4V(ision) in the Japanese National Medical Licensing Examination: Evaluation Study

BACKGROUND

Previous research applying large language models (LLMs) to medicine was focused on text-based information. Recently, multimodal variants of LLMs acquired the capability of recognizing images.

OBJECTIVE

We aim to evaluate the image recognition capability of generative pretrained transformer (GPT)-4V, a recent multimodal LLM developed by OpenAI, in the medical field by testing how visual information affects its performance to answer questions in the 117th Japanese National Medical Licensing Examination.

METHODS

We focused on 108 questions that had 1 or more images as part of a question and presented GPT-4V with the same questions under two conditions: (1) with both the question text and associated images and (2) with the question text only. We then compared the difference in accuracy between the 2 conditions using the exact McNemar test.

RESULTS

Among the 108 questions with images, GPT-4V's accuracy was 68% (73/108) when presented with images and 72% (78/108) when presented without images (P=.36). For the 2 question categories, clinical and general, the accuracies with and those without images were 71% (70/98) versus 78% (76/98; P=.21) and 30% (3/10) versus 20% (2/10; P≥.99), respectively.

CONCLUSIONS

The additional information from the images did not significantly improve the performance of GPT-4V in the Japanese National Medical Licensing Examination.

NIH Licensing Would Benefit from Free-Market Provisions

Government encouragement of free markets is a highly effective means of fostering pharmaceutical innovation; the NIH, by including "free-market provisions" in its licensing agreements that discourage anti-competitive and research-impeding behavior, can do a great deal to support this goal even without legislative overhaul.

Alternative Pathways to Social Work Licensure: A Critical Review and Social Equity Policy Analysis

PURPOSE

In August 2022, the Association of Social Work Boards released a long called for pass rate analysis that revealed significant disparities. While many states look to cease the requirement of the Bachelors, Masters, and Advanced Generalist exams in their licensure process, status quo bias leads to hesitancy to remove the requirement of the Clinical exam.

METHOD

A critical review was undertaken to identify possible alternatives to the current multiple-choice competency-based exam which yielded three assessment formats (oral exams, portfolios, and performance assessment/simulations) and two alternatives (jurisprudence exams and provisional licensure). Informed by an Afrocentric lens, we undertook a social and racial policy analysis to examine alternative pathways for licensure from the perspective of a social work board member. We centered our analysis on the impacts on (1) Black social workers, who currently have the highest pass-rate disparities; (2) social workers whose primary language is not English, and (3) social workers with disabilities who have anecdotally reported difficulty with getting testing accommodations. We rated each alternative on four social equity analysis criteria of procedural fairness, access, quality, and outcomes. These ratings were computed into an overall rating for each alternative from equitable to inequitable.

RESULTS

We found jurisprudence exams and provisional licensure have the best possibility of being equitable pathways to licensure, with potential impacts on the regulation of supervision and continuing education.

CONCLUSION

Anti-racism and social justice as praxis require social work as a profession to divest from competency-based testing to eliminate racism in our own professional policies.

Does a local Alcohol Health Champion programme have a measurable impact on health and crime outcomes? A natural experiment evaluation of Communities in Charge of Alcohol (CICA) based on triangulation of methods

BACKGROUND AND AIM

Drinking alcohol may cause harm to an individual's health and social relationships, while a drinking culture may harm societies as it may increase crime rates and make an area feel less safe. Local councils in Greater Manchester, UK, developed the Communities in Charge of Alcohol (CICA) intervention, in which volunteers were trained to give alcohol-related advice to the public and taught how to influence policies to restrict when, where and how alcohol is sold. As part of a larger study, the aim of the current project is to measure the impact of CICA on health and crime outcomes at the lower super output (LSOA) geographical aggregation.

DESIGN

Quantitative evaluation using four time series analytic methods (stepped-wedge design, and comparisons to local controls, national controls and synthetic controls) with findings triangulated across these methods. A cost-benefit analysis was carried out alongside the effectiveness analysis.

SETTING AND PARTICIPANTS

The general public in Greater Manchester, UK, between 2010 and 2020.

MEASUREMENTS

The primary outcome of interest was alcohol-related hospital admissions. Secondary outcomes were accident and emergency (A&E) attendances, ambulance callouts, recorded crimes and anti-social behaviour incidents.

FINDINGS

Triangulation of the results did not indicate any consistent effect on area-level alcohol-related hospital admissions, A&E attendances, ambulance callouts, reported crimes or anti-social behaviour associated with the implementation of CICA. The primary stepped-wedge analysis indicated an increase in alcohol-related hospital admissions following the implementation of CICA of 13.4% (95% confidence interval -3.3%, +30.1%), which was consistent with analyses based on other methods with point estimates ranging from +3.4% to 16.4%.

CONCLUSION

There is no evidence of a measurable impact of the Communities in Charge of Alcohol (CICA) programme on area-level health and crime outcomes in Greater Manchester, UK, within 3 years of the programme start. The increase in alcohol-related hospital admissions was likely the result of other temporal trends rather than the CICA programme. Possible explanations include insufficient follow-up time, too few volunteers trained, volunteers being unwilling to get involved in licensing decisions or that the intervention has no direct impact on the selected outcomes.

Perspectives of African American Social Workers Regarding Clinical Licensure

PURPOSE

This study was undertaken to illuminate the perspectives of African American MSWs, both licensed and unlicensed, concerning clinical licensure.

METHOD

In 2022, but prior to the time of the Association for Social Work Boards (ASWB) report release, the primary author interviewed 20 African Americans with Master of Social Work (MSW) degrees regarding their desire and attempts to attain licensure. The participants were selected utilizing non-probability, convenience sampling methods and self-selected in response to invitations extended via social media platforms. The interviews took place via Zoom and were recorded and analyzed utilizing qualitative methods.

RESULTS

The findings suggested that many interviewees do view the test as biased in favor of White women and that they attribute lower test pass rates of African Americans in part to this bias. However, additional concerns, including the costs and difficulty of multiple test-taking efforts, the time limit between MSW and licensure, and the dearth of information available to MSWs about licensing credentials, among others, were also cited. Respondents also identified, in some cases, limitations in social support, particularly in work settings, for their professional development efforts. Significantly, many participants identified problems with supervision - securing supervision, the focus/content of supervision, or both.

DISCUSSION AND CONCLUSIONS

Recommendations for steps to increase access to the test and to information about the test are offered. Importantly, discussion regarding avenues to supervision and mentorship is initiated. This study offers a first step in the process of engaging with African Americans about their own experiences with the licensing process.

Becoming Woke by the ASWB Pass Rates: A Closer Look at Racial Inequities in Social Work

There has been widespread outrage within the social work profession regarding racial disparities in pass rates of licensing exams developed and administered by the Association of Social Work Boards (ASWB). The most supported remedy has been to eliminate testing for some categories of licensure with Connecticut, Illinois, and Rhode Island leading the way. Standardized testing has historically been a gatekeeping practice criticized for its exclusionary nature with no empirical evidence linking it to more competent mental health and other social work practice. Thus, the profession is correct in questioning an exam's relevance in social work regulation. However, the licensure test has become a lightning rod issue preventing more substantive analyses, debate, and antiracist reforms within the profession's policy, practice, and education arenas. This article uses the disparity in ASWB pass rates as the impetus for a more critical look at systemic issues in social work adversely impacting Black individuals entering the profession. The authors acknowledge that an anti-racist agenda in social work requires tackling long-standing problems that will not be as easily solved as eliminating multiple choice testing.

An evaluation of dental continuing professional development programs in the USA and Canada

PURPOSE

This research explores continuing professional development (CPD) requirements for dental regulatory/licensing authorities located in the USA/Canada and their preferences toward different learning and assessment strategies.

METHODS

Data were first retrieved through an environmental scan of CPD requirements posted on the websites for the 62 regulatory/licensing authorities located in the USA/Canada. Subsequently, an electronic questionnaire was distributed to the appropriate contact at each regulatory authority to capture additional data related to knowledge and preferences.

RESULTS

The environmental scan revealed that Canadian CPD programs had a significantly higher (p < 0.05) average of required CPD hours (26.67 ± 5.44) when compared to the USA (18.20 ± 4.23). For the survey component, 35 completed responses were received (response rate 56%). A total of 54% of respondents selected from a Likert scale that they "rarely" incorporate formative assessments, and 68% only "sometimes" or "often" incorporate summative assessments into their CPD programs. Additionally, 63% of respondents "never" incorporated predisposing activities, and 57% "never" incorporated reinforcing activities. It was perceived that renewal fees were insufficient to finance ongoing CPD costs (60%) and external industry sponsorships were required to sustain programs (43%). Respondents indicated that there is an insufficient number of evidence-based courses available in a variety of dental disciplines.

CONCLUSIONS

Formative and summative assessments and predisposing and reinforcing learning activities were not viewed as essential tools in CPD programs. Costs and human resources could be possible obstacles in incorporating learning activities and assessments. Future studies can build from the initial results of this study to improve the quality of learning in CPD programs.

Racial Disparity in Social Work Professional Licensure Exam Pass Rates: Examining Institutional Characteristics and State Licensure Policy as Predictors

PURPOSE

The Association of Social Work Boards (2022a) released a report evidencing test-taker demographics as the strongest predictor of professional licensure exam pass-rates. The purpose of this study was to examine statistical predictors of social work professional licensure exam pass rate disparities between first-time Black/African American and White test-takers.

MATERIALS AND METHODS

The study addressed the following research question: To what extent do institutional and state licensure characteristics predict race-based disparities in social work licensure exam pass rates? To answer this question, the authors built a data set in an Excel spreadsheet comprised of institutional and state licensure variables using publicly available and reliable sources.

RESULTS

States requiring more clinical supervision hours and imposing higher licensure fees tended to report higher overall pass rates on the ASWB exam. Additionally, a notable correlation was found between states with a higher proportion of Black/African American residents and increased pass rates. Conversely, states that had established a larger number of licensure tiers typically saw lower overall pass rates. Furthermore, it was noted that schools located in the Southern U.S. demonstrated significantly lower ASWB pass rates compared to schools in other regions of the country.

DISCUSSION

Recommendations are made regarding future research efforts and professional licensure and regulation standards.

CONCLUSION

Pass rate disparities have implications for individual exam-takers and their families; for clients and constituencies; and for social work practice, research, ethics, and education.

Preparing Nurse Educator Students for the New National Council of State Boards of Nursing NCLEX and AACN Essentials

BACKGROUND

Graduate nursing education students are required to complete essential core content (such as education theory, accreditation, evidence-based teaching strategies, and evaluation methods) to prepare them to transition into independent practice. The 2021-2022 academic year required a monumental change in the existing curriculum to incorporate the 2021 American Association of Colleges of Nursing Essentials and the Next Gen National Council Licensure Examination (NCLEX) content.

METHOD

An innovative, prioritized, learner-centered, backward design was used to update the existing curriculum to add the new core content to the nursing education student curriculum.

RESULTS

The end of program comprehensive exams revealed that the students were able to successfully develop a test blueprint, utilizing case studies with Next Gen NCLEX question types designed to measure clinical judgment, and map to the 2021 AACN Essentials.

CONCLUSION

The timely implementation of the curriculum revisions resulted in the achievement of desired student learning outcomes. [J Nurs Educ. 2024;63(3):192-196.].

Deconstructing Social Work Exam Bias: Advocacy Practice Guidelines to Close the Gap

INTRODUCTION

The social work profession is in a precarious situation regarding licensure. Test takers of color are struggling to pass social work licensure exams at rates comparable to their White counterparts, per data released by the Association of Social Work Boards (ASWB). As a nation, we are required to meet the needs of our increasingly diverse population. Yet the recruitment and retention of a diverse body of social workers is unlikely to be actualized if disparities persist in these exams. Given ASWB's monopoly on social work exams and the likelihood that many states will continue to require the exams for licensure, we sought to explore public responses to the data released, using the National Association of Social Work (NASW) as our starting point. As the nation's largest association of social workers, having local chapters within each state, NASW serves as an area of connection between social workers nationwide.

METHODS

We utilized content analysis to explore emerging themes and conduct a review of the state chapter's public responses to exam pass rate data.

RESULTS

A variety of state chapter's responses, with few states engaging in advocacy efforts or taking action to facilitate change.

DISCUSSION

Advocacy efforts play a pivotal role in the restructuring of fragmented systems. This study revisits seemingly ignored disparities diverse test takers may face, while also serving as a call-to-action in advocacy engagement. We conclude with a set of advocacy practice guidelines for use in the promotion of equitable licensing opportunities for all test takers.

ChatGPT-4: An assessment of an upgraded artificial intelligence chatbot in the United States Medical Licensing Examination

PURPOSE

ChatGPT-4 is an upgraded version of an artificial intelligence chatbot. The performance of ChatGPT-4 on the United States Medical Licensing Examination (USMLE) has not been independently characterized. We aimed to assess the performance of ChatGPT-4 at responding to USMLE Step 1, Step 2CK, and Step 3 practice questions.

METHOD

Practice multiple-choice questions for the USMLE Step 1, Step 2CK, and Step 3 were compiled. Of 376 available questions, 319 (85%) were analyzed by ChatGPT-4 on March 21st, 2023. Our primary outcome was the performance of ChatGPT-4 for the practice USMLE Step 1, Step 2CK, and Step 3 examinations, measured as the proportion of multiple-choice questions answered correctly. Our secondary outcomes were the mean length of questions and responses provided by ChatGPT-4.

RESULTS

ChatGPT-4 responded to 319 text-based multiple-choice questions from USMLE practice test material. ChatGPT-4 answered 82 of 93 (88%) questions correctly on USMLE Step 1, 91 of 106 (86%) on Step 2CK, and 108 of 120 (90%) on Step 3. ChatGPT-4 provided explanations for all questions. ChatGPT-4 spent 30.8 ± 11.8 s on average responding to practice questions for USMLE Step 1, 23.0 ± 9.4 s per question for Step 2CK, and 23.1 ± 8.3 s per question for Step 3. The mean length of practice USMLE multiple-choice questions that were answered correctly and incorrectly by ChatGPT-4 was similar (difference = 17.48 characters, SE = 59.75, 95%CI = [-100.09,135.04], t = 0.29, p = 0.77). The mean length of ChatGPT-4's correct responses to practice questions was significantly shorter than the mean length of incorrect responses (difference = 79.58 characters, SE = 35.42, 95%CI = [9.89,149.28], t = 2.25, p = 0.03).

CONCLUSIONS

ChatGPT-4 answered a remarkably high proportion of practice questions correctly for USMLE examinations. ChatGPT-4 performed substantially better at USMLE practice questions than previous models of the same AI chatbot.

The violent death toll from the Iraq War: 2003-2023

From the beginning of the Iraq war, in March of 2003, to the present day, controversy has swirled around the death toll of the war. This paper narrows down the range of uncertainty for the numbers and trends in violent deaths in the war. I assemble and appraise all primary sources that cover the period from March of 2003 onwards-six sample surveys plus a casualty recording project (Iraq Body Count [IBC]). Data permitting, I present cumulative monthly figures with, for the surveys, 95% bootstrapped uncertainty intervals. The analysis uncovers a core of high-quality mainstream sources that are highly consistent with each another. In addition, there are three outlier surveys that are compromised by serious flaws and produce estimates far outside the mainstream. Discarding the outlying and flawed surveys reveals a clear picture of the violent death toll from the Iraq war. IBC figures, extended to include combatants, occupy a central position within the mainstream range of estimates. The strong consistency across the high-quality sources provides a rare validation of three war-death-measurement methodologies-household-based surveys, sibling-based surveys, and casualty recording. Methodological success notwithstanding, we must transcend the numbers to truly comprehend the human costs of the war.

Performance of ChatGPT on Chinese national medical licensing examinations: a five-year examination evaluation study for physicians, pharmacists and nurses

BACKGROUND

Large language models like ChatGPT have revolutionized the field of natural language processing with their capability to comprehend and generate textual content, showing great potential to play a role in medical education. This study aimed to quantitatively evaluate and comprehensively analysis the performance of ChatGPT on three types of national medical examinations in China, including National Medical Licensing Examination (NMLE), National Pharmacist Licensing Examination (NPLE), and National Nurse Licensing Examination (NNLE).

METHODS

We collected questions from Chinese NMLE, NPLE and NNLE from year 2017 to 2021. In NMLE and NPLE, each exam consists of 4 units, while in NNLE, each exam consists of 2 units. The questions with figures, tables or chemical structure were manually identified and excluded by clinician. We applied direct instruction strategy via multiple prompts to force ChatGPT to generate the clear answer with the capability to distinguish between single-choice and multiple-choice questions.

RESULTS

ChatGPT failed to pass the accuracy threshold of 0.6 in any of the three types of examinations over the five years. Specifically, in the NMLE, the highest recorded accuracy was 0.5467, which was attained in both 2018 and 2021. In the NPLE, the highest accuracy was 0.5599 in 2017. In the NNLE, the most impressive result was shown in 2017, with an accuracy of 0.5897, which is also the highest accuracy in our entire evaluation. ChatGPT's performance showed no significant difference in different units, but significant difference in different question types. ChatGPT performed well in a range of subject areas, including clinical epidemiology, human parasitology, and dermatology, as well as in various medical topics such as molecules, health management and prevention, diagnosis and screening.

CONCLUSIONS

These results indicate ChatGPT failed the NMLE, NPLE and NNLE in China, spanning from year 2017 to 2021. but show great potential of large language models in medical education. In the future high-quality medical data will be required to improve the performance.

An exploratory study of parent acceptance of sanctions for driving offenses committed by their children

OBJECTIVE

Graduated driver licensing (GDL) systems are effective at reducing young driver crashes but rely on active parental involvement. However, some parents may accept sanctions (e.g., demerit points, monetary fines) for traffic offenses committed by their children, leading to experiences of punishment avoidance by young drivers. This aim of this exploratory study was to investigate several demographic and psychosocial influences that could possibly be associated with parent acceptance of sanctions.

METHOD

An online survey was completed by parents of young drivers (N = 149, M = 48.88 years, SD = 4.76 years; female = 86%) from 3 Australian states. The survey included measures of sociodemographic characteristics and driving history (e.g., crash involvement), socioeconomic status, parenting style, knowledge of their child's driving behavior, perceptions of their ability to manage their child's driving, attitudes toward GDL, and previous or potential acceptance of demerit points or payment of fines for road offenses committed by their child.

RESULTS

Twenty-nine percent of parents had accepted or would accept a sanction on behalf of their child. Number of children overall, number of children licensed, and household income were associated with parent acceptance of a sanction. Parenting style, attitude toward GDL restrictions, parent confidence in their knowledge of GDL restrictions and ability to manage their child's driving, and belief that their child would follow rules were not associated with (non)acceptance of a sanction.

CONCLUSIONS

These exploratory findings suggest that family size and income may be important influences on parent acceptance of sanctions on behalf of their offending children. The findings related to the psychosocial variables are discussed considering other research and the limitations of the study.

Have your say on Welsh government proposals

The Welsh government is calling for perspectives on the proposed Sustainable Farming Scheme and the licensing of animal welfare establishments, activities and exhibits.

Nurses' Perceptions of Licensure Compact Legislation to Facilitate Interstate Practice: Results From the 2022 Michigan Nurses' Study

States are struggling to assure an adequate number of registered nurses are active in the clinical workforce to serve patients and communities. Nurse compact legislation-enacted in 39 states-facilitates interstate recognition of nurse licensure. We used a cross-sectional email survey of registered nurses in Michigan to measure their opinions on compact licensure legislation and examined differences in compact licensure opinions by nurses' personal characteristics. Primary analyses reported herein are from 7,098 Michigan nurses with complete data. Most respondents felt that the compact would make it easier to redeploy nurses in an emergency (76.6%), improve access to nursing care (66.6%), and boost their personal career options (55.1%). Most nurses disagreed that compact legislation would weaken patient protections (60.7%). The majority expressed neutral feelings on whether compact licensure would make disciplinary actions more difficult to enforce (50.9%) and a plurality that current licensure policies were satisfactory (44.0%). The majority were supportive of Michigan joining the compact (72.3%). In multivariable analysis, stronger support for joining the compact was associated with advanced degrees, male sex, and younger age. Less support was associated with membership in a collective bargaining unit. Policymakers who wish to ease acute nurse vacancies should consider enacting nurse licensure compact legislation. Careful attention to patient protections and disciplinary review would address potential safety concerns.

First-round accreditation and pass rates on licensing examination at different medical schools in China: Closing the performance gap

BACKGROUND

Although the accreditation approach is widely used to ensure the quality of medical education in many countries, there is scant empirical evidence on whether and how it improves actual medical school performance. We focused on conditions in China, which introduced an accreditation system during the 2010s. Specifically, we examined the relationship between first-round accreditation and actual performance based on the results of medical licensing examinations. Referring to organisation theory, we hypothesised that the impacts of accreditation would depend on existing performance gaps.

METHOD

In 2022, we analysed panel data from 105 Chinese medical schools during accreditation (2012 to 2021) and pass rates on medical licensing examinations (2011 to 2019), as matched into 834 school-year records in a window of years before and after accreditation. We employed fixed-effects regression models with a comparison group to exclude factors that may have confounded the impacts of accreditation time. We also demonstrated the heterogeneous effects of accreditation by tier and performance gap of medical schools.

RESULTS

The conservative estimates showed a substantial cumulative improvement (over 15 percentage points) in pass rates during the years before accreditation, with no clear trend indicating performance drops in the years after accreditation. Lower-tiered medical schools gained greater benefits from accreditation. Medical schools with a larger prior performance gap achieved a greater percentage point increase in pass rates with the passage of time in pre-accreditation years.

CONCLUSIONS

This is the first empirical study to investigate whether accreditation has bridged performance gaps among medical schools. The results support the value of accreditation in China, a country that recently established the system, and might work as a substitute for missing information on early accreditation history in countries with long-established accreditation systems. We encourage more studies in countries that have recently introduced accreditation systems.

The CRISPR Cas patent files, part 1: Cas9 - Where to we stand at the 10 year halftime?

CRISPR Cas9 has turned out to be one of the most influential technologies in the life sciences. However, ferocious patent debates and an unclear licensing situation makes access to this technology difficult for Small and medium enterprises. This article gives an overview of the status quo 10 years after the seminal patents were filed.

More to Offer Than Direct Clinical Benefit: FDA's Vaccine Licensure Process Ignores Population Health and Social Determinants of Disease

The current US Food and Drug Administration (FDA) licensure process underestimates the potential benefits of vaccines at both the individual and population levels by considering only direct clinical outcomes of vaccination. While all approved vaccines do protect the person who takes them from poor clinical outcomes for a specific infectious disease, many vaccines also have the potential to offer measurable, direct nonclinical benefits. For example, coronavirus disease 2019 (COVID-19) vaccinations for school-aged children may prevent school absenteeism. Also, by preventing infection or reducing its length and severity, some vaccines also protect-to some extent-the patient's immediate contacts from contracting the same disease. These nonclinical and population-level benefits are not considered as part of the FDA's current vaccine approval process, but they could be. We argue that the FDA's structured benefit-risk assessment framework, used for vaccine approvals, can and should consider both clinical and nonclinical benefits of vaccination when sufficient evidence exists to make an informed assessment. Including them could incentivize vaccine developers to measure additional vaccination effects, inform population health, and address health inequalities-including inequalities in the social determinants of health.

Victimization in Unethical Unlicensed Small Residential Care Homes in the United States: The Case for Whole System Disruption

In the United States, small residential care homes provide affordable community-based care for disabled older adults. Also called adult foster care homes, residential care facilities, group homes, or board and care homes, small residential care homes are typically private, small businesses operating in single-family dwellings that provide round-the-clock care in a home-like setting in residential neighborhoods. While most states license small residential care homes they also exist, legally and illegally, as unlicensed and unregulated operations. The quality of care in some unlicensed and unregulated small residential care homes can be questionable. Disabled older adults are targeted and victimized by unethical small residential care home operators for financial gain. This commentary highlights the need for whole system disruption to end victimization in unethical unlicensed and unregulated small residential care homes through case studies of the abuse and neglect of residents living in unethical unlicensed operations and recommends ambitious goals centered on reducing secondary financial gains and medically neglectful practices. These recommendations are at federal, state, and local levels, and include creating a federal definition of small residential care homes, increasing and coupling government incomes with state registration and employee misconduct registry checks, increasing oversight and assessment, improving temporary guardianship processes, providing avenues for reporting abuse, and developing older adult fatality review teams.

Reporting Requirements, Confidentiality, and Legal Immunity for Physicians Who Report Medically Impaired Drivers

Importance

Physicians play an important role in assessing patients' ability to drive. There is a dearth of peer-reviewed information on policies regarding physician reporting of medically impaired drivers.

Objective

To investigate state reporting requirements and the availability of confidentiality and legal immunity for physicians who report medically impaired drivers.

Design, Setting, and Participants

This cross-sectional study was conducted from November 1 to 30, 2022, in 3 rounds. First, all 50 US states' Department of Motor Vehicle (DMV) websites were systematically reviewed. Second, DMV staff from each state were surveyed via telephone. Third, each state's legal codes for driver licensing were reviewed.

Main Outcomes and Measures

Outcome measures included the percentage of states with mandatory and voluntary reporting policies, reporting instructions on DMV websites, anonymous reporting options, and legal immunity for reporting physicians, in addition to characteristics of states' mandatory reporting policies (ie, types of medical conditions that require reporting) and policies surrounding the confidentiality of reports. The data were analyzed using descriptive statistics.

Results

One-third of state DMV websites (17 [34%]) lacked instructions regarding physician reporting. Six states had mandatory reporting requirements; 4 of these states only required reporting of conditions characterized by lapses of consciousness. Only 3 states (6%) accepted anonymous reports, and 7 states (14%) deemed physician reports of medically impaired drivers confidential without exception. Nearly one-third of states (15 [30%]) deemed reports by physicians confidential, with the exception that reported drivers could find out who reported them if they asked for a copy of the reporting form. Most states (37 [74%]) had statutes that protected physicians from liability related to reporting medically impaired drivers.

Conclusions and Relevance

This cross-sectional study of state reporting requirements regarding medically impaired drivers found many differences in state policies regarding mandatory reporting and the conditions that require reporting. There was also limited availability of online reporting instructions, anonymous reporting options, and legal protections for reporting physicians.

A comparison of licensed driver counts from the Federal Highway Administration and driver licensing agencies in 11 states

Objective: Those who study motor vehicle crashes may rely on counts of licensed drivers to estimate crash, injury, or fatality rates. These counts may be obtained from the U.S. Department of Transportation Federal Highway Administration's (FHWA) annual Highway Statistics Series or directly from state driver licensing agencies. However, previous studies have questioned the accuracy of these counts provided by the FHWA.Methods: To investigate this issue, we compared counts of licensed drivers from the FHWA and state licensing agencies in 11 states, categorized by sex and age group, from 2013 through 2017. We then assessed the impact of any potential differences by fitting two sets of Poisson regression models to estimate age- and sex-based driver fatality rate ratios. One set of models used counts from the FHWA as the offset and the other used counts from state licensing agencies.Results: Our analysis found that the differences between FHWA and state counts varied markedly. Seven states had substantial differences for at least one age group that spanned the entire study period. In several cases, these differences in license counts were large enough to produce directly contradictory driver fatality rate ratio estimates when comparing age groups.Conclusions: These findings highlight the continued concern regarding the accuracy of licensed driver counts from the FHWA and extend previous studies by illustrating the impact of using FHWA counts on statistical inference. We recommend against using these data for traffic safety research or policy evaluation. Nevertheless, we acknowledge the need for a centralized, easily accessible database for licensed driver data.

Alcohol licensing legislation and licensing system in South-West Nigeria: Implications to regulate physical availability of alcohol

INTRODUCTION

The proliferation of alcohol outlets has led to increased physical availability of alcohol, harmful alcohol consumption and related harm in Nigeria. This study explored alcohol licensing legislations and licensing systems across local government councils (LGC) in South-West, Nigeria.

METHODS

Twenty-four LGCs across three states participated in the study. Data were generated from: (i) documents containing LGC liquor licensing legislations; and (ii) semi-structured interviews conducted with 50 LGC officials (16 legislative council clerks and 34 finance officers [director of finance, rate officers and revenue collectors]) were thematically analysed using NVivo.

RESULTS

Nine of the sampled LGC enacted liquor licence bylaws. These mostly specified categories of liquor licences issued and licensing fees. None of the liquor licence bylaw contained regulations for controlling physical availability of alcohol and outlet density. Finance officials were licensing officers and there were no licensing committees across the LGCs. The LGC officials were unanimous in stating that generating revenue from licensing fees was the main objective for licensing alcohol outlets. The LGCs licensed alcohol outlets indiscriminately and failed to regulate outlet density.

DISCUSSION AND CONCLUSION

The absence of regulations for controlling outlet density has implications for physical availability of alcohol in Nigeria. Our findings strongly suggest the need to develop national liquor licensing legislation with public health objectives and implementing regulations for controlling temporal and spatial availability of alcohol. Each LGC should inaugurate a licensing committee with clearly defined roles and responsibilities for licensing stakeholders such as LGC health officials, law enforcement agencies and community members.

Bacteriophage Production in Compliance with Regulatory Requirements

In this chapter, we discuss production requirements for therapeutic bacteriophage preparations. We review the current regulatory expectancies and focus on pragmatic production processes, implementing relevant controls to ensure the quality, safety, and efficacy of the final products. The information disclosed in this chapter can also serve as a basis for discussions with competent authorities regarding the implementation of expedited bacteriophage product development and licensing pathways, taking into account some peculiarities of bacteriophages (as compared to conventional medicines), such as their specificity for, and co-evolution with, their bacterial hosts. To maximize the potential of bacteriophages as natural controllers of bacterial populations, the implemented regulatory frameworks and manufacturing processes should not only cater to defined bacteriophage products. But, they should also facilitate personalized approaches in which bacteriophages are selected ad hoc and even trained to target the patient's infecting bacterial strain(s), whether or not in combination with other antimicrobials such as antibiotics.

The effectiveness of badging systems in engaging, motivating, and incentivizing students in the mastery of nursing licensure materials

INTRODUCTION

Integrating gamification methods into undergraduate nursing programs has prepared students to pass the nursing comprehensive predictor test and the licensure examination.

LITERATURE REVIEW

Research demonstrates that the motivational factors of game elements like badging and leaderboards are of great value and utility to student engagement and motivation. The badges symbolize achievement, authority, and belonging, whereas leaderboards rank students based on different levels of course engagement.

DISCUSSION

This paper explores the benefits, challenges, and strategies of incorporating digital badges and leaderboards in the undergraduate program. Immersion courses preparing students for professional practice are usually one of the last didactic courses offered in the undergraduate curriculum, designed to integrate all knowledge gained from the nursing program.

IMPLICATIONS FOR AN INTERNATIONAL AUDIENCE

The digital badging system can encourage nurse educators globally to engage, motivate, and power students to achieve professional goals. Furthermore, nursing programs worldwide can benefit from adding digital badges and leaderboards to final semester preparatory courses or any nursing course with the same emphasis.

CONCLUSIONS

Digital badges and leaderboards engage and motivate students to integrate knowledge and skills learned in the nursing program and successfully master nurse licensure materials.

Associations Between State Practice Regulations and Access to Midwifery Care

INTRODUCTION

This study aimed to identify associations between state policies and access to midwifery care. Identifying policies that facilitate increased access to midwives will help policymakers determine the best methods for increasing access to midwives in their states.

METHODS

This cross-sectional study was conducted at the county level as a secondary analysis of National Vital Statistics data from the Natality online database. The unit of analysis was counties with populations of at least 100,000, and the outcome was the proportion of births attended by midwives in 2019. The potential predictors of increased access to midwifery care were independent midwife licensure, independent midwife prescribing, midwife access to hospital medical staff membership, and midwife Medicaid parity. Medicaid provider resources and state statutes verified Medicaid reimbursement rates and eligibility for hospital medical staff privileges. Each state was categorized as an independent or restricted licensure state according to data from the American College of Nurse-Midwives. Data for the control variable, the presence of a midwifery education program, were gathered from the Accreditation Commission for Midwifery Education. The analysis was conducted as a Poisson regression.

RESULTS

There was no association between independent licensing and increased access among all states. Stratifying the analysis by independent licensing law revealed that all but one policy was related to higher rates of midwife attendance at birth. Maximum Medicaid reimbursement correlated with greater access regardless of licensing status. The rate of midwife-attended births in independent licensing states grew as the number of potential predictors in a county increased.

DISCUSSION

Regulatory policies beyond independent licensing are associated with women's access to midwifery services. In independent licensing states, adopting additional policies favorable to midwives may strengthen access to midwifery. Policymakers and regulators can use these findings to identify strategies for accelerating the expansion of midwifery access in their states.

Strategies to expand the distribution of nursing talent in the United States

This panel paper is the third installment in a six-part Nursing Outlook special edition based on the 2022 Emory Business Case for Nursing Summit. The 2022 summit was led by Emory School of Nursing in partnership with Emory School of Business. It convened national nursing, health care, and business leaders to explore possible solutions to nursing workforce crises, including the nursing shortage. Each of the summit's four panels authored a paper in this special edition on their respective topic(s). This panel paper focuses on strategies to optimally distribute nursing talent in rural and underserved areas. It discusses the role of nursing talent distribution in ensuring equity in access to care for U.S. populations. Topics covered include the need for expanded and standardized advanced practice registered nurse (APRN) scope of practice, an expanded nurse licensure compact, reimbursement reforms, and competitive nursing salaries.

Behind the Wheel: Unraveling the Impact of Experience Over Age Over the First 18 Months of Licensure

OBJECTIVE

This study examined how driving attention develops with age and driving.

METHODS

In this observational longitudinal study, 190 adolescents (53% female, 73% Black) were enrolled across four groups: 16- and 18-year olds with and without driving experience. They underwent driving simulation with eye-tracking technology seven times over 18 months. By using a combination of factorial and longitudinal designs, the study examined the individual and combined effects of age and driving experience on driving attention over time.

RESULTS

Licensed participants had higher odds of glancing at safety-critical events initially (OR = 15.01, 95% CI: 1.36-165.53), but these odds decreased at higher driving speeds (b = -0.17, p<.01). Average glance length decreased over time (b = -0.26, p=.01), but less so in licensed participants (b=0.14, p=.01). Several visual behaviors were influenced by environmental and driving factors.

CONCLUSIONS

Motor vehicle crashes (MVCs) are burdensome and costly to society. This study focused on the role of inattention in MVCs, particularly during the risky period of adolescence. Findings indicated that driving experience, as determined by licensure, had a considerable impact on visual behavior in both the short term (within two weeks of obtaining a license) and over the first 18 months of independent driving. Overall, these findings suggest that licensed adolescents are more likely to identify potential hazards on the road and navigate safely. To ensure effective guidance, pediatric psychologists and other professionals should consider the unique circumstances, needs, and concerns of individual patients.

Long-Term Health Benefits of Occupational Licensing: Evidence from Midwifery Laws

During the late 19th and early 20th century, several states mandated midwifery licensing requirements to improve midwives' knowledge, education, and quality. Previous studies point to the health benefits of midwifery quality improvements for maternal and infant health outcomes. This paper exploits the staggered adoption of midwifery laws across states using event-study and difference-in-difference frameworks. We use the universe of death records in the US over the years 1979-2020 and find that exposure to a midwifery licensing law at birth is associated with a 2.5 percent reduction in cumulative mortality rates and an increase of 0.6 months in longevity during adulthood and old age. The effects are concentrated on deaths due to infectious diseases, neoplasm diseases, and suicide mortality. We also show that the impacts are confined among blacks and are slightly larger among males. Additional analyses using alternative data sources suggest small but significant increases in educational attainments, income, measures of socioeconomic status, employment, and measures of height as potential mechanism channels. We provide a discussion on the economic magnitude and policy implication of the results.

Driving Skills at Licensure and Time to First Crash

BACKGROUND AND OBJECTIVES

Young drivers are overrepresented in crashes, and newly licensed drivers are at high risk, particularly in the months immediately post-licensure. Using a virtual driving assessment (VDA) implemented in the licensing workflow in Ohio, this study examined how driving skills measured at the time of licensure contribute to crash risk post-licensure in newly licensed young drivers.

METHODS

This study examined 16 914 young drivers (<25 years of age) in Ohio who completed the VDA at the time of licensure and their subsequent police-reported crash records. By using the outcome of time to first crash, a Cox proportional hazard model was used to estimate the risk of a crash during the follow-up period as a function of VDA Driving Class (and Skill Cluster) membership.

RESULTS

The best performing No Issues Driving Class had a crash risk 10% lower than average (95% confidence interval [CI] 13% to 6%), whereas the Major Issues with Dangerous Behavior Class had a crash risk 11% higher than average (95% CI 1% to 22%). These results withstood adjusting for covariates (age, sex, and tract-level socioeconomic status indicators). At the same time, drivers licensed at age 18 had a crash risk 16% higher than average (95% CI 6% to 27%).

CONCLUSIONS

This population-level study reveals that driving skills measured at the time of licensure are a predictor of crashes early in licensure, paving the way for better prediction models and targeted, personalized interventions. The authors of future studies should explore time- and exposure-varying risks.

Unintended Consequence: Diversity as a Casualty of Eliminating United States Medical Licensing Examination Step 1 Scores

PURPOSE

The purpose of this study was to use a discrete-choice experiment to model the trade-offs evaluators make between academic attributes and demographics when the United States Medical Licensing Examination (USMLE) Step 1 switches to pass/fail.

METHODS

A discrete-choice experiment was administered to faculty members from a geographically diverse mix of 14 academic and community radiology departments in the United States from August through November 2020. Reviewers reviewed 10 applicant pairs with numeric Step 1 scores (part 1) and 10 applicant pairs with a pass Step 1 result (part 2). Applicant attributes included medical school rank, gender, race/ethnicity, USMLE Step 1 score, USMLE Step 2 score, class rank, clerkship honors, and publications. Conditional logistic regression modeled the influence of attribute levels.

RESULTS

Two hundred twelve evaluators completed the study (response rate 59%). The most influential attribute was Step 1 score in part 1 and medical school rank in part 2. The relative importance of race/ethnicity and gender decreased by 25% and 29%, respectively, when Step 1 switches to pass/fail. Evaluators weigh race/ethnicity the strongest when applicants have the same Step 1 score (preference weights of 0.85 for African American, 1.42 for Hispanic, and 0 for White and Asian applicants). Race/ethnicity is relatively more important when Step 1 scores are higher (preference weights of 1.58 for African American, 0.90 for Hispanic, and 0 for White and Asian applicants).

CONCLUSIONS

The loss of numeric Step 1 scores reduced the residency evaluator preference for diversity. Reviewers prioritize underrepresented-in-medicine applicants when Step 1 scores are higher and comparable with White and Asian applicants.

PA access to provider health programs

OBJECTIVE

This study assessed the availability of provider health programs (PHPs) for physician associates/assistants (PAs), as well as the accessibility of information about these resources through state licensing boards and PA constituent organizations.

METHODS

Data were collected through audits of the websites of the PA licensing board and state/district constituent group for each state and the District of Columbia from October to November 2022.

RESULTS

Every state except Massachusetts has a PHP that serves PAs. Review of the 51 respective state licensing board websites revealed that 23 states (45.1%) list PHP information; only 9 states (17.6%) have PHP information listed on state PA constituent organization websites.

CONCLUSIONS

The results of this study indicate that PHPs for PAs are widely available. Unfortunately, the broad availability of PHPs may be limited by the lack of accessible information about these programs in many states.

Learning With a Supervisor Who has Traffic Offences and Young Driver Crashes: The DRIVE Study 13-Year Follow-Up

PURPOSE

Young learner drivers commonly must record substantial supervised practice driving before independent licensure. Supervisory driver requirements can be limited or highly regulated, yet research is lacking on the effectiveness of different approaches. The current objective was to explore whether young drivers who were mostly supervised by someone who they perceived had traffic offences versus no offences had different crash records over a period of 13 years postlicensing.

METHODS

DRIVE is an Australian prospective cohort study of more than 20,000 drivers who were aged 17-24 years and newly licensed during 2003-2004. They completed detailed baseline questionnaires, including whether the person they identified as supervising their learner driving the most had perceived traffic offences in the past 12 months. Responses were linked to their state crash, hospitalization, and death records to 2016. A parametric survival model was created to calculate hazard ratios of time to crash for those reporting that their supervisor had 0 versus 1 and 0 versus 2+ perceived offences, adjusting for the participants' prior crash history and other covariates.

RESULTS

After adjusting for covariates, 369 participants reporting supervisory drivers with 2+ perceived offences, compared to 15,451 participants reporting no such offences, had up to 1.67 (95% confidence interval 1.10-2.53 at 6 months) times the rate of any crash for the first 2.5 years and up to 2.01 (95% confidence interval 1.26-3.19 at 3.5 years) times the rate of crashes resulting in injury for 5.5 years.

DISCUSSION

Although overall supervision by a driver with two or more perceived offences was low, further attention is needed to ensure improved supervised driving experiences, with mentoring programs and professional instructor partnerships worthy of exploration.

Promoting transportation safety in adolescence: the drivingly randomized controlled trial

BACKGROUND

The impact of young drivers' motor vehicle crashes (MVC) is substantial, with young drivers constituting only 14% of the US population, but contributing to 30% of all fatal and nonfatal injuries due to MVCs and 35% ($25 billion) of the all medical and lost productivity costs. The current best-practice policy approach, Graduated Driver Licensing (GDL) programs, are effective primarily by delaying licensure and restricting crash opportunity. There is a critical need for interventions that target families to complement GDL. Consequently, we will determine if a comprehensive parent-teen intervention, the Drivingly Program, reduces teens' risk for a police-reported MVC in the first 12 months of licensure. Drivingly is based on strong preliminary data and targets multiple risk and protective factors by delivering intervention content to teens, and their parents, at the learner and early independent licensing phases.

METHODS

Eligible participants are aged 16-17.33 years of age, have a learner's permit in Pennsylvania, have practiced no more than 10 h, and have at least one parent/caregiver supervising. Participants are recruited from the general community and through the Children's Hospital of Philadelphia's Recruitment Enhancement Core. Teen-parent dyads are randomized 1:1 to Drivingly or usual practice control group. Drivingly participants receive access to an online curriculum which has 16 lessons for parents and 13 for teens and an online logbook; website usage is tracked. Parents receive two, brief, psychoeducational sessions with a trained health coach and teens receive an on-road driving intervention and feedback session after 4.5 months in the study and access to DriverZed, the AAA Foundation's online hazard training program. Teens complete surveys at baseline, 3 months post-baseline, at licensure, 3months post-licensure, 6 months post-licensure, and 12 months post-licensure. Parents complete surveys at baseline, 3 months post-baseline, and at teen licensure. The primary end-point is police-reported MVCs within the first 12 months of licensure; crash data are provided by the Pennsylvania Department of Transportation.

DISCUSSION

Most evaluations of teen driver safety programs have significant methodological limitations including lack of random assignment, insufficient statistical power, and reliance on self-reported MVCs instead of police reports. Results will identify pragmatic and sustainable solutions for MVC prevention in adolescence.

TRIAL REGISTRATION

ClinicalTrials.gov # NCT03639753.

Residency Program Directors' Views on Research Conducted During Medical School: A National Survey

PURPOSE

With the United States Medical Licensing Examination Step 1 transition to pass/fail in 2022, uncertainty exists regarding how other residency application components, including research conducted during medical school, will inform interview and ranking decisions. The authors explore program director (PD) views on medical student research, the importance of disseminating that work, and the translatable skill set of research participation.

METHOD

Surveys were distributed to all U.S. residency PDs and remained open from August to November 2021 to query the importance of research participation in assessing applicants, whether certain types of research were more valued, productivity measures that reflect meaningful research participation, and traits for which research serves as a proxy. The survey also queried whether research would be more important without a numeric Step 1 score and the importance of research vs other application components.

RESULTS

A total of 885 responses from 393 institutions were received. Ten PDs indicated that research is not considered when reviewing applicants, leaving 875 responses for analysis. Among 873 PDs (2 nonrespondents), 358 (41.0%) replied that meaningful research participation will be more important in offering interviews. A total of 164 of 304 most competitive specialties (53.9%) reported increased research importance compared with 99 of 282 competitive (35.1%) and 95 of 287 least competitive (33.1%) specialties. PDs reported that meaningful research participation demonstrated intellectual curiosity (545 [62.3%]), critical and analytical thinking skills (482 [55.1%]), and self-directed learning skills (455 [52.0%]). PDs from the most competitive specialties were significantly more likely to indicate that they value basic science research vs PDs from the least competitive specialties.

CONCLUSIONS

This study demonstrates how PDs value research in their review of applicants, what they perceive research represents in an applicant, and how these views are shifting as the Step 1 exam transitions to pass/fail.