Student engagement in math and science is vital to students' academic achievement and longterm participation in science, technology, engineering, and mathematic (STEM) courses and careers. In this study, we conducted in-depth interviews with 106 students from sixth to twelfth grade and 34 middle and high school teachers about how they conceptualized math and science engagement and disengagement. Our qualitative analysis of student and teacher interviews supported the multidimensional construct of engagement outlined in the academic literature. Our analysis also revealed additional indicators that have been included in prior measures of engagement less frequently. We then described how we used this qualitative information from students and teachers to develop and validate a new student self-report measure of math and science engagement.

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Racial and ethnic disparities persist in access to the liver transplantation (LT) waiting list; however, there is limited knowledge about underlying system‐level factors that may be responsible for these disparities. Given the complex nature of LT candidate evaluation, a human factors and systems engineering approach may provide insights. We recruited participants from the LT teams (coordinators, advanced practice providers, physicians, social workers, dieticians, pharmacists, leadership) at two major LT centers. From December 2020 to July 2021, we performed ethnographic observations (participant–patient appointments, committee meetings) and semistructured interviews (N = 54 interviews, 49 observation hours). Based on findings from this multicenter, multimethod qualitative study combined with the Systems Engineering Initiative for Patient Safety 2.0 (a human factors and systems engineering model for health care), we created a conceptual framework describing how transplant work system characteristics and other external factors may improve equity in the LT evaluation process. Participant perceptions about listing disparities described external factors (e.g., structural racism, ambiguous national guidelines, national quality metrics) that permeate the LT evaluation process. Mechanisms identified included minimal transplant team diversity, implicit bias, and interpersonal racism. A lack of resources was a common theme, such as social workers, transportation assistance, non–English‐language materials, and time (e.g., more time for education for patients with health literacy concerns). Because of the minimal data collection or center feedback about disparities, participants felt uncomfortable with and unadaptable to unwanted outcomes, which perpetuate disparities. We proposed transplant center–level solutions (i.e., including but not limited to training of staff on health equity) to modifiable barriers in the clinical work system that could help patient navigation, reduce disparities, and improve access to care. Our findings call for an urgent need for transplant centers, national societies, and policy makers to focus efforts on improving equity (tailored, patient‐centered resources) using the science of human factors and systems engineering.

Vascular Composite Allotransplantation (VCA) is a promising therapy for select patients with tissue loss or dysfunction. 1 In the United States, 104 VCA transplants have been performed to date since the country's first unilateral upper extremity transplant in 1999. 2 In 2014, the Organ Procurement and Transplantation Network (OPTN) approved national standards and policies for vascularized composite allografts. 3 Because VCA is uncommon, the general public may not consider VCA donation when joining a national or state donation