Medicine and Health Sciences Commons^™

Pharmacy Staff Perspectives On Alcohol And Medication Interaction Prevention Among Older Rural Adults, Faika Zanjani, Hannah Allen, Rachel Vickers Smith, Demetra Antimisiaris, Nancy Schoenberg, Catherine Martin, Richard Clayton

Gerontology Publications

Older adults are at high risk for alcohol and medication interactions (AMI). Pharmacies have the potential to act as ideal locations for AMI education, as pharmacy staff play an important role in the community. This study examined the perspectives of pharmacy staff on AMI prevention programming messaging, potential barriers to and facilitators of older adult participation in such programming, and dissemination methods for AMI prevention information. Flyers, telephone calls, and site visits were used to recruit 31 pharmacy staff members who participated in semistructured interviews. A content analysis of interview transcriptions was conducted to identify major themes, categories, and subcategories. …

Improving Resident Understanding Of Healthcare Business And Policy Through The Development Of A High-Yield And Dynamic Educational Series, John Legge

Health Sciences Education Symposium

Objective: Residents have a strong desire to be engaged in and learn about the financial and societal impact of health care delivery and reform initiatives1,2. In order to address this need, a Business and Health Policy Educational Series was developed, with positive feedback from participating residents. Background: During the Program Evaluation Committee (PEC) meeting, as part of the annual review of the ACGME education curriculum for the Virginia Commonwealth University Neurology Residency Program, a deficiency was identified with regard to resident self-perception of understanding of the business and policy of healthcare and reform initiatives. This deficiency is one shared at …

Improving The Clinical Learning Environment: A Collaborative Workshop For Students, Residents, And Faculty, Deborah Diazgranados

Health Sciences Education Symposium

The AAMC Graduation Questionnaire (AAMC GQ) surveys the students at the completion of their training. Results from this survey show that students report mistreatment and unprofessional behavior during their training. The results of this survey, both locally and nationally, motivated faculty in the school of medicine to develop a workshop that would introduce the learning climate to students, and allow the students to interact with faculty to understand mistreatment and professionalism in the learning environment. In this presentation, we will highlight the need for educating students about the learning climate, professionalism and mistreatment; provide attendees with the definition of mistreatment; …

Central Venous Catheter Confirmation By Ultrasonography: A Novel Instructional Protocol, Jordan Tozer

Health Sciences Education Symposium

Central Venous Catheter Confirmation by Ultrasonography: A Novel Instructional Protocol

Implementation Of A Multi-Pronged Approach To Improve Education In Quality Improvement (Qi) And To Increase Resident Involvement In Qi Work, Ashlie Tseng

Health Sciences Education Symposium

Objective: To evaluate a multi-tiered approach to incorporating QI and PS training and participation in a pediatrics residency program. Methods: We developed a multi-tiered approach to QI/PS training during the 2013-14 year, and expanded upon it during subsequent years. We tracked resident participation in Departmental QI Grand Rounds and ACGME and Department survey results. The initial intervention involved didactic and small group sessions/to facilitate project development. We also instituted Departmental QI Grand Rounds. In the following year (2014-15), we increased the number of didactics and started a practice improvement project within the resident group practice where residents were provided individualized …

Teaching Cross-Sectional Anatomy In Parallel With Gross Anatomy Through A Curriculum Incorporating Ct Scanning Of Cadavers, Peter Haar

Health Sciences Education Symposium

Navigating and interpreting cross-sectional medical image sets are important skills used by most physicians to apply anatomical knowledge to patient care. However, few medical schools provide formal instruction in understanding cross-sectional anatomy. For these reasons, a curriculum was developed in which the medical school gross anatomy cadavers were CT scanned prior to dissection, and CT images of specific cadavers were correlated both to labelled atlas images and to direct structural observations of those same cadavers during dissection. The students were taught to navigate CT data sets in axial, coronal, and sagittal planes, to mentally synthesize three-dimensional understandings of individual cadaveric …

Implementation Of A School-Wide, Epa-Based Acting Internship Curriculum, Adam Garber

Health Sciences Education Symposium

Objectives. The core entrustable professional activities for entering residency (Core EPAs) were established by the AAMC as a framework to assess competency. The Acting Internship (AI) rotation is an excellent space to assess core EPAs, however many institutions have no structured AI curriculum. Our goal is to develop a standardized, school-wide AI curriculum that includes evaluation and assessment of designated core EPAs. Method. At our institution, two non-departmental AI directors were directed to oversee all AI rotations across the school and implement goals, objectives, and curriculum focused around specific core EPAs. A clinical skills-focused curriculum combining a mix of didactic …

Medical Rhetoric-Making The Case For Oral Presentations, Patrick Fadden

Health Sciences Education Symposium

The oral case presentation is a vital skill in clinical medicine. It not only serves the purpose of delivering clinical information but it also provides the platform in which providers explain diagnostic reasoning. Although it plays a central role in clinical care, the development and refinement of these communicative skills are often “trial and error” in medical training. This may lead to delayed acquisition in skill development which can impact the efficiency and effectiveness of patient care. The intent and purpose of the oral case presentation also has been shown to be incongruent among medical students and attendings, further dampening …

Why Residents’ Perceptions Of The Clinical Learning Environment Matter: Correlations Between The Acgme Resident Survey, Perceived Organizational Support, And Psychological Safety, Nital Appelbaum

Health Sciences Education Symposium

Purpose. To utilize two validated instruments to assess the cultural facets of the clinical learning environment in medical education and correlate findings with external program evaluation data. Identification of measurement tools could allow early intervention in graduate medical education to better facilitate work and learning processes. Method. During FY17, our institution surveyed residents across nineteen training programs on perceived organizational support and psychological safety to assess the clinical learning environment. These data were aggregated to the departmental level and correlated with nineteen residency program results on the FY17 ACGME Resident Survey. Results. Perceived organizational support correlated positively with domains of …

Leadership Skills Development For Pediatric Residents, Hadi Anwar

Health Sciences Education Symposium

Physicians are expected to be leaders. Pediatrics residents have identified a lack of leadership development in their training. Some residency programs have developed skills-based leadership curriculums that are perceived positively by participants. A leadership curriculum is being developed for VCU pediatrics residents in a fellowship track. A needs assessment was done to identify high-priority leadership skills. The curriculum aims to improve communication, conflict resolution, decision-making, and time management skills using role-play, reflection, and feedback from direct observation. Expected challenges are developing appropriate instructors and time constraints. Curriculum creators will collect evaluations from participants and qualitative feedback to continually improve the …

Quick Qi: A Two-Week Self-Directed Quality Improvement Project, Charles Leiner

Health Sciences Education Symposium

The Accreditation Council for Graduate Medical Education endorses a formal longitudinal quality improvement (QI) curriculum. Our internal medicine program’s tandem-block schedule, in which residents rotate through two-week blocks, creates a unique challenge in teaching QI to internal medicine residents. To overcome the educational barriers of a two-week rotation, we created a short, self-directed QI curriculum to introduce basic QI theory and methods. Through this curriculum, we aim to expose residents to existing QI activities, showcase institutional QI endeavors, foster resident-driven QI projects, and develop teaching experience in the realm of QI and patient safety. The curriculum involves residents in institutional …

Converting Serious Safety Events Into Educational Opportunities, Michael Joseph Vitto

Health Sciences Education Symposium

Over the past year, the Associate Director of the Simulation Center worked with the EM Quality and Safety Director to identify serious safety events (SSE) and critical incidents. As part of the case review, an informal root cause analysis (RCA) was conducted and root causes related to safety risks or breakdowns were identified. These system vulnerabilities were woven into simulation cases for hospital code team training. The cases focused on skills and attitudes that would help prevent, capture, or mitigate similar vulnerabilities while providing clinical care. The objective of this educational innovation was to intentionally translate lessons learned from SSE …

Teaching Quality Improvement In A Pediatric Residency Program, Tamar Springel

Health Sciences Education Symposium

The Accreditation Council for Graduate Medical Education (ACGME) requires residents to demonstrate competence in practice-based learning and improvement (PBLI) and systems-based practice (SBP), two competencies dependent on the principles and practice of quality improvement (QI). In addition, pediatric residents at VCUHS are required to complete a QI project during their residency. We judged the pediatric residents to be sub-par in achieving these competencies as demonstrated by the quality of projects submitted during the last academic year, and set out to improve the QI education they receive by designing a longitudinal curriculum integrating both didactic (using lectures and on-line modules provided …

Emergency Medicine Elective Impact On Third-Year Medical Student Specialty Choice, Nathan Lewis

Health Sciences Education Symposium

Emergency Medicine (EM) is a competitive, sought-after specialty among medical students (1). National standardized curricula have been developed for both third-year (M3) and fourth-year (M4) rotations (2-3), however, there is variability in course implementation (4). Additionally, it is unclear to what extent earlier rotations help students choose a specialty. We developed a two-week elective course to allow M3 students exposure to EM earlier than previously allowed at our medical school. Students were asked to complete an entry survey describing their specialty interests and sources of influence. During the course, students were encouraged to observe the environment and speak to providers, …

The Use Of Interactive Holographic Technology To Teach Surgical Anatomy And Improve Self-Perceived Preparedness For Surgery In Urogynecology, Lauren Siff

Health Sciences Education Symposium

Abstract Purpose: One of the biggest challenges teaching urogynecologic surgery is developing a spatial understanding of the 3-Dimensional relationships of musculature, ligamentous supports and neurovasculature of the pelvic floor. Therefore, we created an innovative curriculum to improve trainee-preparedness for complex vaginal surgery. The aim of the study is to determine if an interactive holographic curriculum will improve self-perceived preparedness, surgical knowledge and learner-satisfaction compared to usual self-study. Methods: This is a prospective study of 18 OB/GYN residents. Participants prepared like they were “scrubbing into a case of uterosacral ligament suspension (USLS) and sacrospinous ligament fixation (SSLF).” They then completed a …

Fighting Frailty With The Mediterranean Diet, Edward F. Ansello

Director's Editorials from Age in Action

It’s appropriate for each of us to examine our eating habits, not just our nutrition intake. The various aspects of the Mediterranean Diet hold potential benefits beyond the important feature of helping to reduce frailty.

Lewy Body Dementia, Edward F. Ansello

Director's Editorials from Age in Action

While Alzheimer’s disease is the most common and widely known cause of dementia, it is not the only cause. Dementia with Lewy Bodies (DLB), in fact, may be the second most common cause of progressive dementia but it is certainly less well known.

Our Anniversary, Edward F. Ansello

Director's Editorials from Age in Action

The Virginia Center on Aging celebrates 40 years.

Addressing The Spiritual Needs Of People Aging With Dementia And/Or Lifelong Disabilities, Kathy Fogg Berry

Case Studies from Age in Action

Educational Objectives

1. Present the need for spiritual care as part of holistic care for people living with dementia and/or lifelong disabilities.

2. Distinguish the difference between spirituality and religion.

3. Discuss how to assess the spiritual needs of people living with dementia and/or lifelong disabilities.

4. Show through case study examples specific ways to address the spiritual needs of people living with dementia and/or lifelong disabilities.

Gerontology Theory Communicated In The Primary Grades Through Picture Books, Edward F. Ansello

Case Studies from Age in Action

Educational Objectives

1. To recognize children’s first literature as a means of socialization to aging and older people.

2. To identify children’s books that reflect basic principles of gerontology theory.

3. To help primary school teachers, grandparents, and others interested in human development use books and activities to capture children’s attention.

4. To identify a unit of six brief, overlapping modules, each with objectives, activities, and recommended readings.

Into The Elder Law Trenches At Wake Forest University School Of Law, Kate Mewhinney

Case Studies from Age in Action

Educational Objectives:

1. Examine the benefits of a medical-legal partnership for training law students how to represent older clients.

2. Review common legal issues in the field of elder law.

3. Explore broader policy concerns facing an aging population.

Silver Saddles: An Equestrian Intervention For Older Adults With Dementia, Christine Jensen, Jessica Lyon, Tina Thomas, Rachel Scrivano

Case Studies from Age in Action

Educational Objectives

1. Demonstrate the encouraging outcomes therapeutic horseback riding programs can have for older adults with memory loss.

2. Describe the importance of trained volunteers and staff at both the riding center and the long-term care community for aiding older adults with memory loss during the therapeutic riding program.

3. Showcase the research process and pilot results.

4. Highlight lessons learned and future directions for Silver Saddles.

Prospective Longitudinal Study Of The Pregnancy Dna Methylome: The Us Pregnancy, Race, Environment, Genes (Preg) Study, Dana M. Lapato, Sara Moyer, Emily Olivares, Ananda B. Amstadter, Patricia A. Kinser, Shawn J. Latendresse, Colleen Jackson-Cook, Roxann Roberson-Nay, Jerome F. Strauss, Timothy P. York

Human and Molecular Genetics Publications

Purpose The goal of the Pregnancy, Race, Environment, Genes study was to understand how social and environmental determinants of health (SEDH), pregnancy-specific environments (PSE) and biological processes influence the timing of birth and account for the racial disparity in preterm birth. The study followed a racially diverse longitudinal cohort throughout pregnancy and included repeated measures of PSE and DNA methylation (DNAm) over the course of gestation and up to 1 year into the postpartum period.

Participants All women were between 18 and 40 years of age with singleton pregnancies and no diagnosis of diabetes or indication of assisted reproductive technology. …

Fostering Transformative Learning, Self-Reflexivity And Medical Citizenship Through Guided Tours Of Disadvantaged Neighborhoods, E. Marshall Brooks, Mary Lee Magee, Mark Ryan

Family Medicine and Population Health Publications

Background and objectives: Medical school curricula increasingly seek to promote medical students’ commitment to redressing health disparities, but traditional pedagogical approaches have fallen short of this goal. The objective of this work was to assess the value of using community-based guided tours of disadvantaged neighborhoods to fill this gap.

Methods: A total of 50 second-year medical students participated in a guided tour of disadvantaged public housing neighborhoods in Richmond, Virginia. Students completed self-reflexive writing exercises during a post-tour debriefing session. Student writings were analyzed to assess the tour’s effect on their awareness of poverty’s impact on vulnerable populations’ health …

B1 Cell Ige Impedes Mast Cell-Mediated Enhancement Of Parasite Expulsion Through B2 Ige Blockade, Rebecca K. Martin, Sheela R. Damle, Yolander A. Valentine, Matthew P. Zellner, Briana N. James, Joseph C. Lownik, Andrea J. Luker, Elijah H. Davis, Martha M. Demeules, Laura M. Khandjian, Fred D. Finkelman, Joseph F. Urban Jr., Daniel H. Conrad

Microbiology and Immunology Publications

Helminth infection is known for generating large amounts of poly-specific IgE. Here we demonstrate that innate-like B1 cells are responsible for this IgE production during infection with the nematode parasites Nippostrongylus brasiliensis and Heligmosomoides polygyrus bakeri. In vitro analysis of B1 cell immunoglobulin class switch recombination to IgE demonstrated a requirement for anti-CD40 and IL-4 that was further enhanced when IL-5 was added or when the B1 source was helminth infected mice. An IL-25-induced upregulation of IgE in B1 cells was also demonstrated. In T cell-reconstituted RAG1^−/− mice, N. brasiliensis clearance was enhanced with the addition of B2 …

Interobserver Reliability In Describing Radiographic Lung Changes After Stereotactic Body Radiation Therapy, Noah S. Kalman, Geoffrey D. Hugo, Jenna M. Kahn, Sherry S. Zhao, Nuzhat Jan, Rebecca N. Mahon, Elisabeth Weiss

Radiation Oncology Publications

Purpose
Radiographic lung changes after stereotactic body radiation therapy (SBRT) vary widely between patients. Standardized descriptions of acute (≤6 months after treatment) and late (>6 months after treatment) benign lung changes have been proposed but the reliable application of these classification systems has not been demonstrated. Herein, we examine the interobserver reliability of classifying acute and late lung changes after SBRT.

Methods and materials
A total of 280 follow-up computed tomography scans at 3, 6, and 12 months post-treatment were analyzed in 100 patients undergoing thoracic SBRT. Standardized descriptions of acute lung changes (3- and 6-month scans) include diffuse …

Monitoring Frequency Of Intra‐Fraction Patient Motion Using The Exactrac System For Linac‐Based Srs Treatments, Benjamin C. Lewis, William J. Snyder, Siyong Kim, Taeho Kim

Radiation Oncology Publications

Purpose: The aim of this study was to investigate the intra‐fractional patient motion using the ExacTrac system in LINAC‐based stereotactic radiosurgery (SRS).

Method: A retrospective analysis of 104 SRS patients with kilovoltage image‐guided setup (Brainlab ExacTrac) data was performed. Each patient was imaged pre‐treatment, and at two time points during treatment (1st and 2nd mid‐treatment), and bony anatomy of the skull was used to establish setup error at each time point. The datasets included the translational and rotational setup error, as well as the time period between image acquisitions. After each image acquisition, the patient was repositioned using the calculated …

Medical Literary Messenger (Vol. 5, No. 2, Spring/Summer 2018)

Medical Literary Messenger

The Essentials / Dave Morrison -- Sometimes I Pretend / Emily Pineau -- Psalm for Anorexia / Elizabeth Gauffreau -- On Harvey Dent / Bryan Walpert -- On the Level / Jane Blanchard -- Cirrhosis / Arthur Ginsberg -- Open Microphone / Stuart M. Terman -- Guest Lavatory, Beaumont Hospital, Day Five / John Jeffire -- Change of Heart / Rosie Sorenson -- Code Blue / Caroline Mosher -- Beautiful Pulses / Paul Hostovsky -- The Hospital and After / Michele Levy -- Mouth to Mouth / Charles H. Halsted -- A Meditation on Memory and Morocco / Janie Breggin …

Medical Literary Messenger (Vol. 6, No. 1, Fall/Winter 2018)

Medical Literary Messenger

Lucky / Erika Walker -- What I Fear / Kathleen Walsh Spencer -- Swimming Alone / Charles Grosel -- This Is What We Had / Marissa S. McNamara -- Study of Skull / Annalyn Welp -- Origin of an Epidemic / John Graham-Pole -- Shedding Light / Sharon Fain -- Beam of Healing: The Trigeminal Neuralgia Series / Douglas W. Johnson -- First Shower / Tracy Rothschild Lynch -- Death Sentence / Barry Peters -- The Diagnosis / Roger Hart -- Drive By / Tony Reevy -- Heart (Ink), 2017 / Laurie Wacks -- Brain (Ink), 2015 / Laurie Wacks …

Identifying Medication Management Smartphone App Features Suitable For Young Adults With Developmental Disabilities: Delphi Consensus Study, Teresa M. Salgado, Alexa Fedrigon, Donna Riccio Omichinski, Michelle A. Meade, Karen B. Farris

Pharmacotherapy and Outcomes Science Publications

Background: Smartphone apps can be a tool to facilitate independent medication management among persons with developmental disabilities. At present, multiple medication management apps exist in the market, but only 1 has been specifically designed for persons with developmental disabilities. Before initiating further app development targeting this population, input from stakeholders including persons with developmental disabilities, caregivers, and professionals regarding the most preferred features should be obtained.

Objective: The aim of this study was to identify medication management app features that are suitable to promote independence in the medication management process by young adults with developmental disabilities using a Delphi consensus …