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An accumulation of research evidence suggests that early pubertal timing plays a significant role in girls' behavioral and emotional problems. If early pubertal timing is a problematic event, then early developing Black girls should manifest evidence of this crisis because they tend to be the earliest to develop compared to other girls from different racial and ethnic groups. Given the inconsistent findings among studies using samples of Black girls, the present study examined the independent influence of perceived pubertal timing and age of menarche on externalizing behaviors and depressive symptoms in a nationally representative sample of Black girls (412 African American and 195 Caribbean Black; M = 15 years). Path analysis results indicated that perceived pubertal timing effects on externalizing behaviors were moderated by ethnic subgroup. Caribbean Black girls' who perceived their development to be early engaged in more externalizing behaviors than Caribbean Black girls' who perceived their development to be either on-time or late. Age of menarche did not significantly predict Black girls' externalizing behaviors and depressive symptoms. The onset of menarche does not appear to be an important predictor of Black girls' symptoms of externalizing behavior and depression. These findings suggest ethnic subgroup and perceived pubertal timing are promising factors for better understanding the adverse effects of early perceived pubertal timing among Black girls.

Objective: To evaluate the prevalence of incivility among trainees and faculty in cardiothoracic surgery, general surgery, plastic surgery, and vascular surgery in the U.S, and to determine the association of incivility on job and work withdrawal and organizational commitment. Background: Workplace incivility has not been described in surgery and can negatively impact the well-being of individuals, teams, and organizations at-large. Methods: Using a cross-sectional, web-based survey study of trainees and faculty across 16 academic institutions in the U.S., we evaluated the prevalence of incivility and its association with work withdrawal and organizational commitment. Results: There were 486 (18.3%) partial responses, and 367 (13.8%) complete responses from surgeons [including 183 (56.1%) faculty and 143 (43.9%) residents or fellows]. Of all respondents, 92.2% reported experiencing at least 1 form of incivility over the past year. Females reported significantly more incivility than males (2.4 ± 0.91 versus 2.05 ± 0.91, P < 0.001). Asian Americans reported more incivility than individuals of other races and ethnicities (2.43 ± 0.93, P = 0.003). After controlling for sex, position, race, and specialty, incivility was strongly associated with work withdrawal (β = 0.504, 95% CI: 0.341–0.666). There was a significant interaction between incivility and organizational commitment, such that highly committed individuals had an even greater impact of incivility on the outcome of job and work withdrawal (β = 0.178, 95% CI: 0.153–0.203). Conclusions: Incivility is widespread in academic surgery and is strongly associated with work withdrawal. Leaders must invest in strategies to eliminate incivility to ensure the well-being of all individuals, teams, and organizations at-large. [ABSTRACT FROM AUTHOR]

Supplemental Digital Content is available in the text Background: Intraoperative resident autonomy has been compromised secondary to expectations for increased supervision without defined parameters for safe progressive independence, diffusion of training experience, and more to learn with less time. Surgical residents who are insufficiently entrusted during training attain less autonomy, confidence, and even clinical competency, potentially affecting future patient outcomes. Objective: To determine if OpTrust, an educational intervention for increasing intraoperative faculty entrustment and resident entrustability, negatively impacts patient outcomes after general surgery procedures. Methods: Surgical faculty and residents received OpTrust training and instruction to promote intraoperative faculty entrustment and resident entrustability. A post-intervention OpTrust cohort was compared to historical and pre-intervention OpTrust cohorts. Multivariable logistic and negative binomial regression was used to evaluate the impact of the OpTrust intervention and time on patient outcomes. Setting: Single tertiary academic center. Participants: General surgery faculty and residents. Main Outcome(s) and Measure(s): Thirty-day postoperative outcomes, including mortality, any complication, reoperation, readmission, and length of stay. Results: A total of 8890 surgical procedures were included. After risk adjustment, overall patient outcomes were similar. Multivariable regression estimating the effect of the OpTrust intervention and time revealed similar patient outcomes with no increased risk (P > 0.05) of mortality {odds ratio (OR), 2.23 [95% confidence interval (CI), 0.87–5.6]}, any complication [OR, 0.98 (95% CI, 0.76–1.3)], reoperation [OR, 0.65 (95% CI, 0.42–1.0)], readmission [OR, 0.82 (95% CI, 0.57–1.2)], and length of stay [OR, 0.99 (95% CI, 0.86–1.1)] compared to the historic and pre-intervention OpTrust cohorts. Conclusions: OpTrust, an educational intervention to increase faculty entrustment and resident entrustability, does not compromise postoperative patient outcomes. Integrating faculty and resident development to further enhance entrustment and entrustability through OpTrust may help facilitate increased resident autonomy within the safety net of surgical training without negatively impacting clinical outcomes. [ABSTRACT FROM AUTHOR]

Objective: The purpose of this study was to measure the efficacy of a novel faculty and resident educational bundle focused on development of faculty-resident behaviors and entrustment in the operating room. Summary Background Data: As surgical training environments are orienting to entrustable professional activities (EPAs), successful transitions to this model will require significant faculty and resident development. Identifying an effective educational initiative which prepares faculty and residents for optimizing assessment, teaching, learning, and interacting in this model is critical. Methods: From September 2015 to June 2017, an experimental study was conducted in the Department of Surgery at the University of Michigan Health System (UMHS). Case observations took place across general, plastic, thoracic, and vascular surgical specialties. A total of 117 operating room observations were conducted during Phase I of the study and 108 operating room observations were conducted during Phase II following the educational intervention. Entrustment behaviors were rated for 56 faculty and 73 resident participants using OpTrust, a validated intraoperative entrustment instrument. Results: Multiple regression analysis showed a significant increase in faculty entrustment (Phase I = 2.32 vs Phase II = 2.56, P < 0.027) and resident entrustability (Phase I = 2.16 vs Phase II = 2.40, P < 0.029) scores following exposure to the educational intervention. Conclusions: Our study shows improved intraoperative entrustment following implementation of faculty and resident development, indicating the efficacy of this innovative educational bundle. This represents a crucial component in the implementation of a competency-based assessment framework like EPAs. [ABSTRACT FROM AUTHOR]