Medical Education Commons^™

Identifying The Current Status And Future Needs Of Clinical, Educational, And Laboratory Genetics Services In Pakistan: A Web-Based Panel Discussion, Myla Ashfaq, Syed A Ahmed, Rabia Aziz-Rizvi, Zahra Hasan, Salman Kirmani, Shama Munim, Rizwan Naeem, Jamal Raza, Aisha Furqan

Faculty, Staff and Student Publications

While the prevalence of genetic disorders has been well documented in the Muslim-majority, low-socioeconomic country of Pakistan, the provision of medical genetic services remains limited and cost-prohibitive to the masses in the country. With the objective of identifying gaps in the provision of medical genetics services as perceived by the healthcare providers and the general public, the Pakistani Society of Medical Genetics and Genomics (PSMG) organized a needs assessment webinar on December 6, 2020, titled, “A Vibrant Discussion on the Current Status and Future Needs of Medical Genetic Services in Pakistan.” The objectives of the webinar were (1) to explore …

Ontologies Applied In Clinical Decision Support System Rules: Systematic Review, Xia Jing, Hua Min, Yang Gong, Paul Biondich, David Robinson, Timothy Law, Christian Nohr, Arild Faxvaag, Lior Rennert, Nina Hubig, Ronald Gimbel

Faculty, Staff and Student Publications

BACKGROUND: Clinical decision support systems (CDSSs) are important for the quality and safety of health care delivery. Although CDSS rules guide CDSS behavior, they are not routinely shared and reused.

OBJECTIVE: Ontologies have the potential to promote the reuse of CDSS rules. Therefore, we systematically screened the literature to elaborate on the current status of ontologies applied in CDSS rules, such as rule management, which uses captured CDSS rule usage data and user feedback data to tailor CDSS services to be more accurate, and maintenance, which updates CDSS rules. Through this systematic literature review, we aim to identify the frontiers …

N-Of-1 Trials: The Epitome Of Personalized Medicine?, Joyce P Samuel, Susan H Wootton, Jon E Tyson

Faculty, Staff and Student Publications

Observational studies are notoriously susceptible to bias, and parallel-group randomized trials are important to identify the best overall treatment for eligible patients. Yet, such trials can be expected to be a misleading indicator of the best treatment for some subgroups or individual patients. In selected circumstances, patients can be treated in n-of-1 trials to address the inherent heterogeneity of treatment response in clinical populations. Such trials help to accomplish the ultimate goal of all biomedical research, to optimize the care of individual patients.

Age-Induced Changes In Anti-Tumor Immunity Alter The Tumor Immune Infiltrate And Impact Response To Immuno-Oncology Treatments, Suzanne I Sitnikova, Jennifer A Walker, Laura B Prickett, Michelle Morrow, Viia E Valge-Archer, Matthew J Robinson, Robert W Wilkinson, Simon J Dovedi

Faculty, Staff and Student Publications

INTRODUCTION: Immuno-oncology (IO) research relies heavily on murine syngeneic tumor models. However, whilst the average age for a cancer diagnosis is 60 years or older, for practical purposes the majority of preclinical studies are conducted in young mice, despite the fact that ageing has been shown to have a significant impact on the immune response.

METHODS: Using aged (60-72 weeks old) mice bearing CT26 tumors, we investigated the impact of ageing on tumor growth as well as the immune composition of the tumor and peripheral lymphoid organs.

RESULTS: We found many differences in the immune cell composition of both the …

Association Between Surgical Technical Skills And Clinical Outcomes: A Systematic Literature Review And Meta-Analysis, Michael S Woods, Joshua N Liberman, Pinyao Rui, Emily Wiggins, Joan White, Bruce Ramshaw, Jonah J Stulberg

Faculty, Staff and Student Publications

BACKGROUND: A systematic literature review and meta-analysis was conducted to assess the association between intraoperative surgical skill and clinical outcomes.

METHODS: Peer-reviewed, original research articles published through August 31, 2021 were identified from PubMed and Embase. From the 1,513 potential articles, seven met eligibility requirements, reporting on 151 surgeons and 17,932 procedures. All included retrospective assessment of operative videos. Associations between surgical skill and outcomes were assessed by pooling odds ratios (OR) using random-effects models with the inverse variance method. Eligible studies included pancreaticoduodenectomy, gastric bypass, laparoscopic gastrectomy, prostatectomy, colorectal, and hemicolectomy procedures.

RESULTS: Meta-analytic pooling identified significant associations between …

Sustained Increases In Immune Transcripts And Immune Cell Trafficking During The Recovery Of Experimental Brain Ischemia, Munish Saini, Eshan Sengupta, Madanjit Singh, Harnoor Singh, Jaswinder Singh

Faculty, Staff and Student Publications

Sustainable Development Goals (SDG) are at the forefront of government initiatives across the world. The SDGs are primarily concerned with promoting sustainable growth via ensuring wellbeing, economic growth, environmental legislation, and academic advancement. One of the most prominent goals of the SDG is to provide learners with high-quality education (SDG 4). This paper aims to look at the perspectives of the Sustainable Development Goals improvised to provide quality education. We also analyze the existing state of multiple initiatives implemented by the Indian government in the pathway to achieving objectives of quality education (SDG 4). Additionally, a case study is considered …

A Student-Designed Multimodal Sex- And Gender-Based Women's Health Elective Program: Advocacy Curriculum For Medical Students, Lauren M Conroy, Danna Ghafir, Maitreyi Narayan, Hunter Mcspedden, Samuel Neher, S Shahrukh Hashmi, Rebecca Lunstroth

Faculty, Staff and Student Publications

OBJECTIVES: The objective of this article is to describe the design and implementation of a multimodal, student-driven, sex- and gender-based women's health (SGBWH) elective with a curricular focus on patient and legislative advocacy. In this single arm, pre/post design, interventional study, we detail and evaluate the use of social media, newsletters, and round-table discussions in conjunction with a traditional lecture-based educational format to engage medical students in a virtual learning environment.

METHODS: We developed a 22-week SGBWH curriculum for pre-clinical and clinical medical students, which included a series of lectures on multi-specialty and gender-inclusive topics related to SGBWH, small group …

A Facilitated Peer Mentoring Program With A Dedicated Curriculum To Foster Career Advancement Of Academic Hospitalists, Doris Lin, R Michelle Schmidt, Chirayu Shah, Andrew Caruso, Xiaofan Huang, Kristen A Staggers, Joslyn Fisher

Faculty, Staff and Students Publications

INTRODUCTION: In the field of hospital medicine, there is both a limited pool of senior faculty to mentor the rapidly growing number of junior faculty and a lack of career development curricula focused on scholarly activities specific to the needs of the hospitalist. These deficits have resulted in a disproportionately low number of academic hospitalists being promoted to associate and full professor. We implemented a facilitated peer mentoring program with a dedicated curriculum to foster career advancement of academic hospitalists.

METHODS: We recruited 29 academic hospitalists and divided them into five small groups, each guided by one senior faculty. Peer …

A Comparison Of Medical And Pharmacy Student Perspectives Of A Clinical Interprofessional Home-Visit Versus A Virtual Interprofessional Workshop, Anita B Major, Yuanyuan Zhou, Catherine L Hatfield, Kristina M Little, Natalie M Mondragon, Anne C Gill

Faculty, Staff and Students Publications

Background: No Place Like Home is a clinical interprofessional education (IPE) activity whereby pharmacy and medical students conduct home visits under the guidance and supervision of a clinical preceptor to homebound patients.

Purpose: We examined pharmacy and medical student perceptions of mastery of interprofessional competencies during an in-person clinical home visit pre-COVID-19 pandemic versus a virtual IPE learning activity consisting of didactic and case discussions in response to the global COVID-19 pandemic.

Methods: We administered the same modified Interprofessional Collaborative Competency Attainment Survey (ICCAS) instrument, which uses a five-point Likert scale, to both the in-person and the virtual IPE students …

Addressing Training Gaps: A Competency-Based, Telehealth Training Initiative For Community Health Workers, Laura Porterfield, Victoria Warren, Vanessa Schick, Shannon Gulliot-Wright, Jeff R Temple, Elizabeth M Vaughan

Faculty, Staff and Student Publications

BACKGROUND: To overcome vast variations in Community Health Worker (CHW) training, investigators for the CHW Core Consensus Project (CCCP) derived three types of CHW (Category 1, 2, 3) and established competencies for each category. However, studies are needed that implement these competencies in real-world settings.

OBJECTIVE: Using the six competency domains of the CCCP as a theoretical backbone, we developed and evaluated a training for

METHODS: We developed five telehealth-based, bilingual (Spanish/English) training sessions and implemented them among

RESULTS: All (18/18) CHWs achieved at least 70% on the posttest (mean: 93.7%; range 73.3-100%). Training attendance was 98.9%. Using a six-point …

Burnout During The Covid-19 Pandemic: A Report On Pediatric Residents, Linessa M Zuniga, Abigail Schuh, Alan Schwartz, Patricia Seo-Mayer, Rachel Cramton, Kira Sieplinga, Ruchi Kaushik, Lauren Nassetta, Jason H Homme, Jessica Babal, John D Mahan, Maneesh Batra

Faculty, Staff and Students Publications

Background and objective: The Pediatric Resident Burnout and Resilience Consortium (PRB-RSC) has described the epidemiology of burnout in pediatric residents since 2016. We hypothesized burnout rates during the pandemic would increase. We explored resident burnout during the COVID-19 pandemic and its relationship to resident perception of workload, training, personal life, and local COVID burden.

Methods: Since 2016, PRB-RSC has sent an annual, confidential survey to over 30 pediatric and medicine-pediatrics residencies. In 2020 and 2021, seven questions were added to explore the relationship of COVID-19 and perceptions of workload, training, and personal life.

Results: In 2019, 46 programs participated, 22 …

Medical Ethics Principles Underscore Advocating For Human Papillomavirus Vaccine, C Mary Healy, Lara S Savas, Ross Shegog, Rebecca Lunstroth, Sally W Vernon

Faculty, Staff and Student Publications

Studies have consistently shown that vaccination rates against human papillomavirus (HPV) lag far behind other adolescent vaccinations recommended at the same age, resulting in exposing adolescents to unnecessary future risk of infection, and genital and head and neck cancers. Studies also have demonstrated that a major barrier to vaccination is lack of a strong provider recommendation. Factors that providers offer for failing to give a strong recommendation range from perception that the child is not at risk or the need to explain that the vaccine is not mandated (lack of equity and justice) or respect for parental autonomy. We look …

Intestinal Iga-Coated Bacteria In Healthy- And Altered-Microbiomes (Dysbiosis) And Predictive Value In Successful Fecal Microbiota Transplantation, Herbert L Dupont, Zhi-Dong Jiang, Ashley S Alexander, Andrew W Dupont, Eric L Brown

Faculty, Staff and Student Publications

IgA-coated bacteria in the gut (IgA-biome) provide a homeostatic function in healthy people through inhibition of microbial invaders and by protecting the epithelial monolayer of the gut. The laboratory methods used to detect this group of bacteria require flow cytometry and DNA sequencing (IgA-Seq). With dysbiosis (reduced diversity of the microbiome), the IgA-biome also is impaired. In the presence of enteric infection, oral vaccines, or an intestinal inflammatory disorder, the IgA-biome focuses on the pathogenic bacteria or foreign antigens, while in other chronic diseases associated with dysbiosis, the IgA-biome is reduced in capacity. Fecal microbiota transplantation (FMT), the use of …

Collaborative Interprofessional Health Science Student Led Realistic Mass Casualty Incident Simulation, Deborah L Mccrea, Robert C Coghlan, Tiffany Champagne-Langabeer, Stanley Cron

Faculty, Staff and Student Publications

In collaboration, a health science university and a fire department offered a mass casualty incident (MCI) simulation. The purpose of this study was to evaluate a cross-section of student health care providers to determine their working knowledge of an MCI. Students were given a pretest using the Emergency Preparedness Information Questionnaire (EPIQ) and the Simple Triage and Rapid Transport (START) Quiz. The EPIQ instrument related to knowledge of triage, first aid, bio-agent detection, critical reporting, incident command, isolation/quarantine/decontamination, psychological issues, epidemiology, and communications. The START Quiz gave 10 scenarios. Didactic online content was given followed by the simulation a few …

A Forehead Wearable Sensor For The Objective Measurement Of Chronic Pain, Marcus Orzabal, Ramo Naidu, Kasra Amirdelfan, Alireza Akhbardeh

Faculty, Staff and Student Publications

Chronic pain impacts one in five Americans and is difficult to manage, costing ~USD 600 billion annually. The subjective experience of pain is a complex processing of central nervous system input. Recent advances in magnetic resonance imaging revealed the prefrontal cortex as vital to the perception of pain and that changes in the cerebral hemodynamics can be used to detect painful sensations. Current pain monitoring is dependent on the subjective rating provided by patients and is limited to a single time point. We have developed a biomarker for the objective, real-time and continuous chronic pain assessment using proprietary algorithms termed …

Sex-Related Differences In Violence Exposure, Neural Reactivity To Threat, And Mental Health, Heather E Dark, Nathaniel G Harnett, Danielle R Hurst, Muriah D Wheelock, Kimberly H Wood, Adam M Goodman, Sylvie Mrug, Marc N Elliott, Susan Tortolero Emery, Mark A Schuster, David C Knight

Faculty, Staff and Student Publications

The prefrontal cortex (PFC), hippocampus, and amygdala play an important role in emotional health. However, adverse life events (e.g., violence exposure) affect the function of these brain regions, which may lead to disorders such as depression and anxiety. Depression and anxiety disproportionately affect women compared to men, and this disparity may reflect sex differences in the neural processes that underlie emotion expression and regulation. The present study investigated sex differences in the relationship between violence exposure and the neural processes that underlie emotion regulation. In the present study, 200 participants completed a Pavlovian fear conditioning procedure in which cued and …

Reproducing Statistics Performed In Published Randomized Controlled Trials, Naila H Dhanani, Oscar A Olavarria, Cynthia S Bell, Julie L Holihan, Mike K Liang

Faculty, Staff and Student Publications

INTRODUCTION: Randomized controlled trials (RCT) represent evidence at the lowest potential risk for bias. Clinicians in all specialties depend upon RCTs to guide patient care. Issues such as statistical discordance, or reporting statistical results that cannot be reproduced, should be uncommon. Our aim was to confirm the statistical reproducibility of published RCTs.

METHODS: PubMed was searched using "randomized controlled trial." Studies were selected using a random number generator. Studies were included if the primary outcome could be reproduced using the data and statistical test reported in the manuscript. The reproduced p-value from our analysis and the published p-value were compared. …

Hpv-Associated Anal Cancer Knowledge, Attitudes, And Health Communication Behaviors Among Non-Clinical Providers At Hiv/Aids Service Organizations In Southern United States Region, Olufunto A Olusanya, Aditi Tomar, Jonathan Thomas, Praisy Johnson, Lisa T Wigfall

Faculty, Staff and Student Publications

Co-infection with HIV/HPV and bio-behavioral risk factors (e.g., immunodeficiency, un-protected sex) increase likelihood for developing anal and other HPV-associated cancers among people living with HIV/AIDS (PLWHA). We explored knowledge, attitudes, and health communication regarding HPV-associated anal cancers among HIV/AIDS service organization (ASO) employees/volunteers delivering non-clinical services to PLWHA. Participants (n=59) were recruited from six ASOs located in the South United States Census region and completed a 118-item self-administered survey. For current analyses, outcome measures were knowledge, attitudes, and health communication regarding anal cancer. Descriptive statistics assessed outcome measures which were subsequently dichotomized into binary variables (i.e., high/favorable or low/unfavorable). Fisher's …

Assessment For Deeper Understanding Using Concept Maps: Lessons Learned From Flipped Teaching Of Pharmacology, Munder Zagaar, Weichao Chen

Faculty, Staff and Students Publications

To foster a deeper understanding of pharmacology concepts among physician assistant students, we integrated concept mapping into our flipped teaching to provide assessment for learning. Different mapping-based assessment strategies were adopted based on learner feedback, including in-person collaborative mapping, an individual computerized mapping-based quiz with automated feedback, and a collaborative computerized mapping-based quiz enhanced by the jigsaw strategy. Each mapping activity also leveraged the strength of a specific technology platform. Based on the findings from comparing learner ratings of these mapping activities and thematic analysis of learner feedback, we engaged in critical reflection and share our lessons learned.

A Consensus List Of Ultrasound Competencies For Graduating Emergency Medicine Residents, David A Haidar, William J Peterson, Patrick G Minges, Jennifer Carnell, Jason T Nomura, John Bailitz, Jeremy S Boyd, Megan M Leo, E Liang Liu, Youyou Duanmu, Josie Acuña, Ross Kessler, Marco F Elegante, Mathew Nelson, Rachel B Liu, Resa E Lewiss, Arun Nagdev, Rob D Huang

Faculty, Staff and Students Publications

OBJECTIVES: Emergency ultrasound (EUS) is a critical component of emergency medicine (EM) resident education. Currently, there is no consensus list of competencies for EUS training, and graduating residents have varying levels of skill and comfort. The objective of this study was to define a widely accepted comprehensive list of EUS competencies for graduating EM residents through a modified Delphi method.

METHODS: We developed a list of EUS applications through a comprehensive literature search, the American College of Emergency Physicians list of core EUS benchmarks, and the Council of Emergency Medicine Residency-Academy of Emergency Ultrasound consensus document. We assembled a multi-institutional …

Intervening On Impostor Phenomenon: Prospective Evaluation Of A Workshop For Health Science Students Using A Mixed-Method Design, Shine Chang, Hwa Young Lee, Cheryl Anderson, Kava Lewis, Devasmita Chakraverty, Melinda Yates

Faculty, Staff and Student Publications

BACKGROUND: Unaddressed impostor feelings that impede developing interest in science and self-efficacy in conducting research have a dispiriting effect that perpetuates unsatisfactory diversity in the health science workforce when such feelings are experienced more by those historically underrepresented in the workforce. This warrants effective interventions to reduce the impact of impostor feelings and related factors that diminish career resilience. We examined the effects of a 90-minute workshop on impostor perceptions and growth mindset to raise awareness of impostor phenomenon (IP) and develop skills to manage IP successfully for students attending a 10-week summer research experience program.

METHODS: Using a convergent …

Uthealth Quality Symposium 2022 Abstracts-2

Teaching in Clinics

No abstract

Evaluation Of Mrna-1273 Vaccine In Children 6 Months To 5 Years Of Age, Evan J Anderson, C Buddy Creech, Vladimir Berthaud, Arin Piramzadian, Kimball A Johnson, Marcus Zervos, Fredric Garner, Carl Griffin, Khozema Palanpurwala, Mark Turner, Jeffrey Gerber, Richard L Bennett, Kashif Ali, Madhavi Ampajwala, Gary Berman, Jennifer Nayak, Carey Chronis, Barbara Rizzardi, William J Muller, Christopher A Smith, George Fuchs, Daniel Hsia, Joanne E Tomassini, Dianne Delucia, Caroline Reuter, Barbara Kuter, Xiaoping Zhao, Weiping Deng, Honghong Zhou, Daniela Ramirez Schrempp, Kelly Hautzinger, Bethany Girard, Karen Slobod, Roderick Mcphee, Rolando Pajon, Anne Aunins, Rituparna Das, Jacqueline M Miller, Sabine Schnyder Ghamloush, Kidcove Study Group

Faculty, Staff and Student Publications

BACKGROUND: The safety, reactogenicity, immunogenicity, and efficacy of the mRNA-1273 coronavirus disease 2019 (Covid-19) vaccine in young children are unknown.

METHODS: Part 1 of this ongoing phase 2-3 trial was open label for dose selection; part 2 was an observer-blinded, placebo-controlled evaluation of the selected dose. In part 2, we randomly assigned young children (6 months to 5 years of age) in a 3:1 ratio to receive two 25-μg injections of mRNA-1273 or placebo, administered 28 days apart. The primary objectives were to evaluate the safety and reactogenicity of the vaccine and to determine whether the immune response in these …

The Benefits And Challenges Of Virtual Education For Interprofessional Teams In A Post-Covid Environment, Tiffany Champagne-Langabeer

Faculty, Staff and Student Publications

There have been a series of disruptions in the healthcare environment since 2019, starting with the global pandemic [...].

Outcome Prediction In Newborn Infants: Past, Present, And Future, Vivek V Shukla, Matthew A Rysavy, Abhik Das, Jon E Tyson, Edward F Bell, Namasivayam Ambalavanan, Waldemar A Carlo

Faculty, Staff and Student Publications

The perinatal and neonatal periods are the periods of considerable organ development and maturation. Perinatal and neonatal illnesses can result in mortality and morbidities that burden families and the healthcare system. Outcome prediction is essential for informing perinatal and intensive care management, prognosis, and post-discharge interventions. The Eunice Kennedy Shriver National Institute of Child Health and Human Development Neonatal Research Network (NRN) research databases include hospital and neurodevelopment follow-up outcomes of infants with various underlying diseases and conditions receiving intensive care, providing a unique opportunity to assess outcome risk prediction. The NRN has developed outcome risk prediction tools for use …

Evaluating The Clinical Impact Of A Novel Pediatric Emergency Medicine Curriculum On Asthma Outcomes In Belize, Adeola A Kosoko, Amelia A Khoei, Swapnil Khose, Alicia E Genisca, Joy M Mackey

Faculty, Staff and Student Publications

BACKGROUND: Respiratory-related complaints prompt most pediatric visits to Karl Heusner Memorial Hospital Authority's (KHMHA) Emergency Department (ED) in Belize. We developed and taught a novel pediatric respiratory emergencies module for generalist practitioners there. We assessed the curriculum's clinical impact on pediatric asthma emergency management.

OBJECTIVE: This study assesses the clinical impact of a pediatric emergency medicine curriculum on management of pediatric asthma emergencies at KHMHA in Belize City, Belize.

METHODS: We conducted a randomized chart review of pediatric (aged 2-16 y) visits for asthma-related diagnosis at the KHMHA ED between 2015 and 2018 to assess the training module's clinical impact. …

Participation In A Longitudinal Seminar Series Increases Medical Student Engagement With The Covid-19 Pandemic, Katherine M Naeger, Kaelyn C Cummins, Prathit A Kulkarni

Faculty, Staff and Students Publications

OBJECTIVES: The coronavirus disease 2019 (COVID-19) pandemic required a multifaceted response by healthcare professionals. Medical students played only a limited role in the early response, resulting in feelings of disengagement. The authors developed a discussion-based elective course reviewing the COVID-19 response to address this gap in medical student education.

METHODS: Preclinical medical students enrolled in this elective participated in weekly virtual interactive seminars led by expert faculty members. Students completed a final survey quantifying their understanding of the overall COVID-19 response, knowledge of its individual facets, and their feelings of personal engagement on a Likert scale from 1 to 5, …

Uthealth Quality Symposium 2022 Abstracts

Teaching in Clinics

No abstract

Characteristics Of Academic Anesthesiologist’S Elected To An Institutional Academy Of Master Educators, Evan G. Pivalizza, Sara Guzman-Reyes, Christopher Stephens, Rhashedah A. Ekeoduru, Omonele O. Nwokolo, Katherine C. Normand, Srikanth Sridhar, Travis H. Markham, Johanna B. Dehaan, George Williams, Gary C. Rosenfeld

Teaching in Clinics

Background. The educational experience and success of academic anesthesiologists may be elusive to quantify. We wished to examine the characteristics of a cohort of anesthesiology faculty who were inducted into a medical school master educator academy over the last decade.

Methods. After IRB approval with waiver of consent, all 10 anesthesiology faculty inductees into the academy supplied relevant data for their accomplishments at the time of induction in multiple educational domains, including teaching and assessment, mentoring and advising, evidence of scholarship and production of enduring materials, and educational leadership. These were deidentified and analyzed.

Results. The cohort had evidence of …

Teaching In Clinics: A New Perspective To Healthcare Education

Teaching in Clinics

No abstract