Medicine and Health Sciences Commons^™

Structured Textbook Review And Individualized Learning Plans Successfully Remediate Underperforming Residents And Improve General Surgery Program Performance On The Absite, Aaron Pinnola, Christoph Kaufmann

HCA Healthcare Journal of Medicine

Background

We endeavored to create an evidence-based curriculum to improve general surgery resident fund of knowledge. Global and resident-specific interventions were employed to this end. These interventions were monitored via multiple choice question results on a weekly basis and American Board of Surgery In-Training Examination (ABSITE) performance.

Methods

This study was performed in a prospective manner over a 2-year period. A structured textbook review with testing was implemented for all residents. A focused textbook question-writing assignment and a Surgical Council on Resident Education (SCORE)-based individualized learning plan (ILP) were implemented for residents scoring below the 35th percentile on the ABSITE. …

Variation In Transcript Reports Among Residency Applicants: An Anesthesia Program’S Perspective, Alex M. Hendon, Imani Thornton

HCA Healthcare Journal of Medicine

Background

With recent changes made to move USMLE Step 1 and COMLEX Level 1 scores to Pass/Fail, it becomes necessary to find other metrics to evaluate residency candidates. One conserved metric included in all residency applications is medical school transcripts. This study aims to highlight the highly varied transcript reporting in a new era of holistic applicant review.

Methods

Medical school transcripts were extracted from the Electronic Residency Application Service applications to our anesthesiology residency program for the 2021-2022 application cycle. All personally identifiable information was removed. Results were categorized and tallied by 2 independent reviewers. Overall, we assessed transcript …

Doctors And Disability: Improving Inclusion In Medical Education, Mary Alice Keller

HCA Healthcare Journal of Medicine

Disability is extremely common in the United States with 26% of adults identifying as having some type of disability. Oftentimes, people with disabilities need to access health care services frequently in order to receive adequate care and support. However, despite this need, medical students receive limited, if any, education about people with disabilities and how to appropriately provide medical care and interact with them. This lack of education exacerbates health care disparities experienced by people with disabilities. This article highlights these disparities as well as the history of disability and health care. Current advancements in medical education regarding people with …

Conference Proceedings: Select Abstracts Presented At 2021 Advocate Aurora Health Scientific Day

Journal of Patient-Centered Research and Reviews

Abstracts published within this supplement were presented at the 47th annual Advocate Aurora Health Scientific Day, held virtually on May 26, 2021. This research symposium provides a forum for disseminating results from studies conducted by faculty, fellows, residents, and other allied health professionals associated with Midwest-based health system Advocate Aurora Health, which publishes the Journal of Patient-Centered Research and Reviews.

The Transitional Year Internship: Five Classes Of Former Interns Reflect On Their First Clinical Year, Hana L. Haver, Kush K. Patel, Robert Chow

Advances in Clinical Medical Research and Healthcare Delivery

Objective:

The clinical internship (postgraduate year-1), which precedes many advanced residency training programs, are traditionally fulfilled by a transitional year (TY) or preliminary year of training in medicine or surgery. TY programs can take place in a variety of settings, ranging from community hospitals to large academic medical centers. In the present study, we sought to evaluate if resident physicians who completed a community hospital-based TY internship felt prepared for their subsequent specialty residency training.

Methods:

A cross-sectional survey was adapted and distributed to resident physicians who completed their TY internship at a university-affiliated community hospital in Baltimore, Maryland, between …

Preparing Internal Medicine Trainees For Independent Practice: A Pilot Simulation Program On Emotional Intelligence, Deborah Maier, Nagesh Jadhav, Christina Goodermote, Richard Alweis

Advances in Clinical Medical Research and Healthcare Delivery

Introduction: Emotional intelligence (EI) is the ability to monitor emotions and use this knowledge to guide one’s thinking and actions. EI shapes the physician’s bedside manner and leads to a better doctor-patient relationship. Higher physician EI is inversely proportional to feelings of burnout and increases resiliency to the stresses of the profession. Given the increasing levels of physician burnout, there has been a call to incorporate the development of emotional intelligence into medical education. However, little guidance exists on best practices in incorporating EI training into graduate medical education.

Purpose/Aim: Utilization of EI simulation as a pedagogical instrument to increase …

Business Cards As A Mechanism To Encourage Patient Feedback About Trainees, Marc Atzenhoefer, Jodie Ruffin, David Parewski, Nicole Deklotz, M. Fuad Jan, Ana Cristina Perez Moreno, Suhail Q. Allaqaband

Journal of Patient-Centered Research and Reviews

This project sought to evaluate if business card distribution improved the utility of Hospital Consumer Assessment of Healthcare Providers and Systems (HCAHPS) surveys by serving as a feedback mechanism for trainees. Between fall 2018 and spring 2019, patient encounters for 6 cardiovascular disease fellows were tracked over two 60-day periods. Six weeks were allowed for HCAHPS surveys to be returned. Business cards were subsequently deployed and encounters similarly tracked. During the control-group monitoring period, 721 patient encounters were logged and 80 (11.1%) surveys were returned. Qualitative feedback, in the form of free-response comments, was provided in 41 (51.3%) surveys. Business …

Localization Of Hand And Wrist Anatomic Structures Among Physical Medicine And Rehabilitation Residents: Implication Of Ultrasonography In Palpation Skill Verification, Se Won Lee, Phuong Uyen Le, Craig Van Dien, Stefanie Lai, Eric Aguila

HCA Healthcare Journal of Medicine

Objective

The objective of this cross-sectional study is to evaluate the accuracy of physical medicine and rehabilitation (PM&R) resident palpation skills of hand and wrist joint and soft tissue structures using ultrasonography (US) verification.

Methods

PM&R residents palpated hand and wrist anatomic structures in an outpatient musculoskeletal (MSK) clinic. Once the presumed structures were localized, residents marked a one centimeter size circle on the overlying skin with an ink marker. The accuracy of the circle over the joint line and soft tissue structures was verified using US.

Results

Overall palpation accuracy for 16 joint line and soft tissue structures was …

An Obstetrics And Gynecology Residency Program’S Approach To The Covid-19 Pandemic, Tiffany C. Chang, Brenda Nguyen, Chi Dola

HCA Healthcare Journal of Medicine

Background: The impact of COVID-19 on residency training nationwide has been substantial, and adapting to this unprecedented event has proven challenging for program directors throughout the United States. Here, the authors presented their initial experiences with restructuring an obstetrics and gynecology residency program during the pandemic. The authors outlined their strategies to maximize resident safety and address clinical care in outpatient and inpatient settings, resident education curriculum, resident wellness and consider the ethical dilemmas of health care providers during a pandemic.

Conclusion: With perspectives from other residency programs, the authors hope this review will serve as an initial building block …

Conference Proceedings: Aurora Scientific Day 2020

Journal of Patient-Centered Research and Reviews

Abstracts published in this supplement were among those presented at the 46th annual Aurora Scientific Day research symposium, held virtually on May 20, 2020. The symposium provides a forum for describing research studies conducted by faculty, fellows, residents, and allied health professionals affiliated with Wisconsin-based Aurora Health Care, a part of the Advocate Aurora Health health system, which publishes the Journal of Patient-Centered Research and Reviews.

Serum Ammonia And Folate Levels: Opportunities For High Value Care, R. Benson Jones Jr., Md, Sean Dikdan, Md, Bracken Babula, Md

The Medicine Forum

High value care encompasses a variety of principles including ordering tests with high diagnostic yield, while reducing low value practice.

Case Report Of E-Cigarette Associated Lung Injury In A Health Female, Mario Fonseca-Paricio, Md, Alan Gandler, Md, Boyd Hehn, Md

The Medicine Forum

This is a case of a woman presenting with four days of diarrhea and dyspenea found to have E-cigarette or vaping-associated lung injury (EVALI)

A Case Report Of Bullous Subconjunctival Hemorrhag In Adenoviral Conjunctivitis, Sean Haynie, Jesse Johnson, Md

The Medicine Forum

A 78-year-old female with a past medical history of optic neuropathy and atrial fibrillation on warfarin presented with two weeks of progressive bilateral eye redness, swelling, pain, and blurry vision.

A Case Report Of Tragaxofusp Causing Severe Tumor Lysis Syndrome In A Patient With Blastic Plasmacytoid Dendritic Cell Neoplasm, Shuwen Lin, Md, Alice Wang, Md

The Medicine Forum

The patient was an 83-year-old male without significant past medical hsitory who presented to his primary care physician with several days of generalized malaise

Exploring The Adverse Effects Of Car-T Therapy: A Cases Report Of Potential Minoca In Car-T, Danielle Verghese, Pgy-1, Adam Binder, Md, Colin Thomas, Md

The Medicine Forum

A 48-year-old man with a history of Stage IV Diffuse Large B-Cell Lymphoma refractory to R-CHOP alternating with high-dose methotrexate and cytarbine, craniospinal irradiation, and haploidentical stem cell transplant, underwent CD 19-directed CAR-T.

A Case Report Of Hemophagocytic Lymphohistiocytosis Secondary To Disseminated Tuberculosis, Shuwen Lin, Md, Christoher Terry

The Medicine Forum

A 72-year-old woman with past medical history of hypertention and type 2 diabsetes presented to the emergency department for one day history of fevers, poor oral intake, and fatigue.

From The Desk Of The Residency Program Director, Emily Stewart, Md, Facp

The Medicine Forum

It has been a historic year for the Nation, City of Philadelphia and teh Jefferson Internal Medicine Residency Program. We have eperienced many health care crises starting with the closure of the historic Philadelphia hospital, Hahnemann. We welcomed residents form this program as part of the Jefferson Family and integrated many patients into our practices.

From The Editors, Eitan Frankel, Md, Guy Katz, Rachel Redfield, Navdeep Sangha, Michael Weintraub, Randi Zukas

The Medicine Forum

We are delighted to present you with the 21st annual edition of The Medicine Forum.Here in the birthplace of our nation, we like to think of The Medicine Forum as being of the housestaff, by the housestaff and for the housestaff. Undeniably, this publication would not be possible without the countless hours dedicated by our residents, students, fellows and faculty.

Table Of Contents: The Medicine Forum Volume 21, 2019-2020

The Medicine Forum

Table of Contents: The Medicine Forum Volume 21, 2019-2020

An Unusual Treatment For Chronic Myelomonocytic Leukemia, Eric Warner, Msiii, Neil Palmisiano, Md

The Medicine Forum

A 76-year-old female with a past medical history of an extraosseous chondrasrcoma status-post-resection thirty years prior, hypertension, hyperlipidemia, and hypothyroidsimm presented to her primary care physicial with fatigue, two weeks of dyspnea on exertion, lightheadedness, and nausea.

Diagnosing Non-Hfe Hereditary Hemochromatosis, Brian Park, Md, Naman Upadhyay, Md, Dina Halegoua-Demarzio, Md

The Medicine Forum

A 63-year-old Caucasian female presented for evaluation of abnormal bile duct appearance on ERCP after being diagnosed with gallstone pancreatitis, duodenal ulcers and gastritis at another hospital.

Pericardial Effusion With Tamponade Physiology In A Patient With Multiple Myeloma, Sairamya Bodempudi, Md, Rukaiya Bashir-Hamidu, Md, Preya Simlote, Md, Shuwen Lin, Md, Philip Margiotta, Md, Tina Boortalary, Md, Gregary D. Marhefka, Md

The Medicine Forum

A 78-yeaer old African American female with a past medical history of IgA Kappa Multiple Myseloma was transfered to the Cardiovascular Intensive Care Unit (CVICU) at Thomas Jefferson University Hospital (TJUH) after being diagnosed with a pericardial effusion with tamponade physiology at an outside hospital.

An Approach To Refractory Hypoxemia, Daniel Garrido, Md, Evan Nardone, Md, Mark Mallozzi, Md

The Medicine Forum

A 74-year-old female with no significant pulmonary history presented as a transfer from an outside hospital for persistent refractory hypoxemia.

Bilateral Intercostal Lung Herniations: A Rare Incidental Finding In A Dyspneic Patient, Jillian Cooper, Md, Christine Kurian, Md

The Medicine Forum

A 63-year-old man with a past medical history of chronic obstructive pulmonary disease (COPD), stage IV sarcoidosis on 3-4 liters of home oxygen and chronic prednisone, moderate aortic stenosis, and a prior aspergilloma for which he had a left upper lobe lung resection presented to the hospital with two weeks of worsening shortness of breath.

The Medicine Forum: Volume 21

The Medicine Forum

The Journal of Thomas Jefferson University Hospital - Department of Internal Medicine, Volume 21, 2019-2020

TABLE OF CONTENTS

Clinical Images

Case Reports

• Cardiology
• Gastroenterology and Hepatology
• Hematology and Oncology
• Infectious Disease
• Pulmonary Medicine

Literature Review

Editorial

Evaluation Of Resident Palpation Skills In Foot And Ankle Anatomic Structures Using Bedside Ultrasound, Se Won Lee, Phuong U. Le, Craig Van Dien, Mike Hansen, Timothy Tiu

HCA Healthcare Journal of Medicine

Objective: The objective is to determine the accuracy of foot and ankle joint and soft tissue structure palpation in Physical Medicine and Rehabilitation (PM&R) residents using ultrasonography (US) verification.

Methods: PM&R residents were tested in an outpatient musculoskeletal (MSK) clinic on palpated foot and ankle anatomic structures in a human model. Once the presumed structures were localized, residents marked a 1 cm size circle on the overlying skin with a ink marker. The accuracy of the circle over the joint line and soft tissue structures was verified using US.

Results: The overall palpation accuracy for 22 joint line and soft …

No Hard Feelings, Colin Thomas, Md

The Medicine Forum

No abstract provided.

To Those Who Don The White Coat, Cuckoo Choudhary, Md

The Medicine Forum

No abstract provided.

Heart Failure With Preserved Ejection Fraction: A Review Of The Acc/Aha Guidelines And Evidence-Based Management Strategy, Vikas Sunder, Md

The Medicine Forum

Introduction

Heart failure with preserved ejection fraction (HFpEF) is a clinical syndrome in which a patient has signs and symptoms of heart failure including dyspnea, fatigue, pulmonary rales, peripheral edema and an ejection fraction greater than 50%.1-4 Approximately half of patients with heart failure have a preserved ejection fraction.2-5 HFpEF is considered a distinct clinical entity from other causes of heart failure with a preserved ejection fraction such as valvular heart disease, pericardial disease, and infiltrative cardiomyopathy. HFpEF carries a poor prognosis, with an annual mortality of 29% in patients discharged after an acute decompensated heart failure admission.5 5-year survival …

A Gram-Negative False-Negative: Normal Procalcitonin Level In A Patient With Multiple Klebsiella Pneumoniae Intra-Abdominal Abscesses: A Case Report And Literature Review, Mario Caldararo, Md

The Medicine Forum

Introduction

Despite over 3,000 peer-reviewed articles on procalcitonin (PCT) since 2004, guidance on its usage is sparse.1 An analysis of more than 500 United States hospitals in the Premier Healthcare Database found large differences in utilization exist across regions (115 PCT encounters per 10,000 patients in the Northeast vs. 408 to 576 in other regions) and teaching vs. non-teaching hospitals (345 vs. 530 PCT encounters per 10,000 patients, respectively).2 The purpose of this work is to describe a case that exemplifies the caveats in PCT interpretation and to summarize the current knowledge of the clinical utilization of PCT.