Journal of general internal medicine
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In medical education, learner self-assessments are standard methods used to evaluate the impact of curricula and workshops. Due to the subjective nature of self-assessment, these measures are prone to known biases including framing, recall, social desirability, and response-shift bias. These biases can contribute to floor and ceiling effects of measurement, which can lead to false conclusions about whether the intended learning objectives were achieved. ⋯ For each design, we review strengths, weaknesses, and known biases and discuss examples to highlight trade-offs between options. We also discuss the use of control groups and follow-up surveys to measure retention over time as additional methods to address bias and related confounding. The guidance presented here is intended to raise educators' awareness of common pitfalls in self-assessment; minimize the impact of known biases when possible; provide evidence, examples, and rationales for optimal design choices; and increase the rigor of self-assessment evaluations.
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Colorectal cancer (CRC) screening is underutilized among those with lower socioeconomic status and in racial and ethnic minoritized populations who have been disproportionately impacted by COVID. ⋯ Among privately insured individuals, CRC screening after the COVID pandemic recovered unevenly based on sex, area-level socioeconomic measures, and metropolitan area status, with pre-pandemic disparities persisting and even worsening for some of the factors.
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Older adults with multimorbidity are underrepresented in clinical trials, with enrollment of Asians particularly low. ⋯ Chinese older adults perceived obstacles to clinical trial participation that could be mitigated by involving trusted physicians in recruitment, using language and culturally concordant materials/staff, and educating patients and community-based physicians. Recognition of differences in attitudes among US- and non-US-born Chinese people may be important to tailoring recruitment strategies.
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Healthcare organizations attempt to address unwarranted fentanyl use, which often leads to increased risk of addiction and overdose. ⋯ Requiring specialist approval for fentanyl initiation for non-oncological chronic pain was associated with a decrease in fentanyl prescription initiations, especially among non-elderly patients. A decrease also occurred gradually in total opioid dispensations, further decreasing following the extension of the requirement to continuous fentanyl. The requirement for specialist approval upon fentanyl initiation and continuous fentanyl may present an effective tool for limiting the use of fentanyl and total opioids in healthcare systems.