Anatomy, Cell Biology & Physiology Department Theses and Dissertations
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Browsing Anatomy, Cell Biology & Physiology Department Theses and Dissertations by Author "Agosto, Elizabeth R."
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Item Experiences of Residency Program Directors in Their Roles: Exploring Well-Being Through Burnout and Engagement(2022-11) Robertson, Kyle A.; Byram, Jessica N.; Hayes, Cleveland; Agosto, Elizabeth R.; McNulty, Margaret A.; Organ, Jason M.Recent literature on well-being of physicians in general, and residency program directors (PD) specifically, has demonstrated those meeting the criteria of burnout reaching almost 50% in physicians, and 20-30% in PDs. However, few studies have explored engagement, or the positive or meaningful aspects, in physicians and no studies have explored engagement in the PD and Assistant PD community. Therefore, this study employed a qualitative approach to explore the experiences of PDs and APDs as they encountered burnout, engagement, and every combination in between through their multifaceted, roles, responsibilities, and tasks embedded in their institutional context and personal lives. Phase 1 participants (n=3) included two PDs and one APD from Indiana University School of Medicine (IUSM). Participants in Phase 1 took part in three semi-structured interviews at 6-month intervals, and direct observations in their clinical, administrative, and education roles. Phase 2 participants (n=5) were PDs from IUSM who completed a single semi-structured interview based on preliminary results and exploration of Phase 1 participants’ experiences. Interviews and field notes from observations were analyzed using inductive thematic analysis, followed by a deductive application of Job Demands-Resources (JD-R) theory. Document analysis was incorporated to add context, understanding, and a rich description of the participants’ experiences. This study found multiple sub-themes situated within four major themes: It Takes a Village, Integration of the “Hats” They Wear, Motivation and the Meaning of Their Career, and Coping. Exploring the sub-themes to JD-R theory allowed contextualization of how job demands, job resources, personal resources, absence of resources, job crafting, recovery, self-undermining, and strain, interact to add context, nuance, and broader conceptualization of how PD and APD experienced their multifaceted roles. This study provides a rich description of the experiences of PDs and APDs embedded in their social context of roles, tasks, and responsibilities. These results indicated that understanding how the individual experiences their job demands as they interact with their experiences of job and personal resources, and how the individual proactively engages with their environment through job crafting and recovery enables for a nuanced appreciation of engagement and burnout.Item Human Skeletal Remains at US Medical Schools: Provenance, Management, and Barriers to Ethical Stewardship(2025-06) Woods, Sabrina Christiane; Byram, Jessica N.; Agosto, Elizabeth R.; McNulty, Margaret A.; Organ, Jason M.; Mussell, Jason C.; Scheurich, James J.Following calls to action to ethically interact with human skeletal remains (HSR), the Task Force for Legacy Anatomical Collections within the American Association for Anatomy published guidelines on how to ethically manage HSR. Despite calls to action and recommendations, the literature lacks empirical investigation into the provenance of HSR and the current state of HSR management at US medical schools. Therefore, the purpose of this study was to investigate the provenance(s) of HSR at US medical schools, their current management, and barriers to improving management. To investigate provenance and current management of HSR, a questionnaire was nationally distributed via email to gross anatomy educators and lab managers identified through an internet search. Results were analyzed using descriptive statistics. To investigate the barriers experienced by faculty and staff in improving HSR management, 60-minute focus groups were conducted; data was analyzed using framework thematic analysis. The Theoretical Domains Framework was applied to the inductively interpreted themes. The results of this work show that provenance for HSR at US medical schools is largely undocumented and that the quality of HSR management varies by operational domain. For example, storage conditions and handling procedures are largely in line with professional recommendations at most medical schools. However, inventories and oversight committees are not active at over half of US medical schools and provenance investigations are not occurring at most US medical schools. Described barriers that hamper improvement of HSR management include ‘Social Influences’ and ‘Environmental Context and Resources’ from a lack of collegial and financial support as well as the management of HSR being a low ‘Goal’ for faculty and staff due to an overload of responsibilities. This work provides empirical evidence that most HSR at US medical schools are of unknown provenance and shows that there are relatively few aspects of HSR management where US medical schools currently excel. It also demonstrates barriers experienced by faculty and staff in improving the management of HSR and provides potential solutions to those barriers. Lastly, this work serves as a further call to action to show HSR the respect and dignity they deserve.Item What's My Role Again? Cultivating Interprofessionalism, Role Knowlege, and Role Clarity Through Case-Based Learning(2024-03) Herriott, Hannah Laine; McNulty, Margaret A.; Byram, Jessica N.; Agosto, Elizabeth R.; Deane, Andrew S.; Rebman, Rebecca; Scheurich, Jim J.As healthcare has shifted away from physician-centered practice, in favor of a patient-centered model, the importance of interprofessional team-based practice was recognized. Early exposure, practice working through clinical cases in teams, and learning each profession’s roles are essential determinants of successful interprofessional collaboration (IPC). Although interprofessional role comprehension is widely accepted as one of four core competencies of interprofessional education (IPE) and lack of role comprehension is associated with medical errors; literature measuring said construct is lacking. Role knowledge and clarity are two crucial skills that encompass identifying the roles and limitations of various professions’ scopes of practice and discerning which professional is best equipped to undertake a task in a particular situation. The present study investigated a novel IPE intervention employing role centered, small group casebased learning (CBL) sessions, integrated throughout an anatomy course for firstsemester occupational therapy (OTD), physical therapy (DPT), and physician assistant (MPAS) students. Additionally, fourth-year medical (MD) students participated in the IPE intervention by serving as near-peer facilitators for each of the small groups. A sequential explanatory, mixed methods design was employed to examine participants’: 1) acquisition of role knowledge, 2) demonstration of role clarity, 3) views of IPC after engaging in CBL sessions, and 4) perceptions of the intervention itself. The present study addressed the previously mentioned gap in the literature by exploring a CBL intervention’s influence on role comprehension (a previously unquantified aspect of IPE), in addition to their IPE-related perceptions. The aforementioned CBL intervention effectively improved role knowledge and clarity when implemented in-person; however, no significant changes were demonstrated in the virtual cohort. While many positive perceptions of the intervention and IPE experience were found, some misconceptions about professions and inhibitory power dynamics were also identified. Despite the latter findings, the CBL intervention examined in this study can serve as an effective model for cultivating IPE through enhanced role knowledge and clarity among health professional students.