Medical Education Commons^™

Harassment And Mental Health In Surgical Training: A Pilot Survey Of Surgical Trainees In Pakistan, Russell S. Martins, Syeda Amrah Hashmi, Hina Inam, Mahin Janjua, Mahim Malik

Medical College Documents

Objective: To assess harassment among surgical trainees and its effects on mental health, and to explore its association with gender.
Methods: The nationwide cross-sectional pilot study was conducted by the Association of Women Surgeons of Pakistan from July to September 2019, and included surgical trainees of either gender working in both public and private hospitals. Data was collected using an anonymous online survey form to assess harassment and self-perceived burnout and depression. Data was analysed using SPSS 22.
Results: Of the 147 respondents, 49(33.3%) were males; 98(66.6%) were females; and 118(80.3%) were residents. Workplace harassment was reported by 80(54.4%) trainees. …

Surgical Education And Training During The Covid-19 Pandemic: Strategies And Solutions For Pakistan, Edward Anthony Joseph, Russell S. Martins, Javeria Tariq, Namrah Aziz, Hina Inam, Mahim Malik

Medical College Documents

The coronovirus disease-2019 pandemic has severely impacted surgical education and training in Pakistan and worldwide, causing problems, such as risk of infection, limited hands-on training, examination delays, and trainee redeployment to non-surgical specialties. The current review was planned to describe innovative strategies adopted by surgical training programmes worldwide in order to suggest comprehensive recommendations at the level of the College of Physicians and Surgeons Pakistan and individual institutions to counter the challenges presented by the pandemic in Pakistan. The innovative use of technology, including open-access online educational portals, virtual educational activities and simulation-based learning, can help reform education delivery during …

Starting Residency With Covid-19, Seena Khosravi, Ashish Sinha

HCA Healthcare Journal of Medicine

Introduction

By Dr. Ashish Sinha, MD, PhD, DABA, MBA, FASA

As a Program Director of a just established anesthesia program, one faces enough challenges. A curve ball that I was not expecting was one of my residents to inform me on July 3rd that he was feeling feverish with chills, had myalgia and a headache. First response in my mind, that I didn’t verbalize was, ”Anosmia too?” I arranged COVID testing ASAP in a drive-by setting, which we could avail immediately. My resident had driven from New Orleans, LA to Riverside, CA, making a few stops along the way, (food, …

Covid-19 Era Requires Urgent Integration Of Virtual Reality Simulations In Medical Education, Halil Tekiner, Cemal Alper Kemaloglu, Achmet Ali Tsaous

HCA Healthcare Journal of Medicine

The COVID-19 pandemic continues to cause an unprecedented level of disruption across every part of the globe. This disruption detrimentally affects the field of medical education; in particular, anatomical, surgical and clinical training, all which require hands-on experience. On the other hand, the pandemic not only brings new challenges in medical education but also opportunities for testing the validity of our old education paradigms and for developing the ability to embrace a rapid pace of change in better integrating new technologies in the medical curriculum. We contend that the future of medical education lies in the successful use of VR …

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 …

Developing Physical Exam Skills In Residency: Comparing The Perspectives Of Residents And Faculty About Values, Barriers, And Teaching Methods, John W. Ragsdale, Catherine Habashy, Sarita Warrier

Internal Medicine Faculty Publications

Background: The physical examination (PE) skills of residents are often not improved since medical school. Unfortunately, how residents learn PE is not well understood. There is a paucity of research on the factors involved and the differences between resident and faculty perspectives. The authors sought to determine resident and faculty perceptions about the value of PE, the major barriers to learning PE, and the most effective teaching methods.

Methods: Based on a rigorous process of literature review and semi-structured interviews, the authors developed an online survey which was sent to 406 internal medicine residents and 93 faculty at 3 institutions. …

Aaim Recommendations For The 2020-2021 Internal Medicine Residency Application Cycle In Response To The Covid-19 Pandemic, Katherine C Chretien, Jaya M Raj, Reeni A Abraham, Paul Aronowitz, Donna J Astiz, Shobhina G Chheda, Ernie L Esquivel, Maria M Garcia, Nadia Ismail, Susan Lane, Suzanne E Mclaughlin, Anne Pereira, Amy W Shaheen, Abby L Spencer, Kimberly M Tartaglia, Lisa L Willett

Faculty, Staff and Students Publications

This statement was released in June 2020 by the Alliance for Academic Internal Medicine to provide guidance for the 2020-2021 residency application cycle in light of the COVID-19 pandemic. While many of the recommendations are specific to this cycle, others, such as the Department Summary Letter of Evaluation, are meant to be an enduring change to the internal medicine residency application process. AAIM realizes that some schools may not yet have the tools or resources to implement the template fully this cycle and look toward collaboration within the internal medicine education community to facilitate adoption in the cycles to come.

Cosmetovigilance: A New Concept For Residency Curriculum, Jennifer Jones, Hale Z. Toklu

HCA Healthcare Journal of Medicine

Primary care physicians need to incorporate “cosmetovigilance” into their post-graduate curriculum to increase their residents’ awareness of the adverse reactions induced by the use of cosmetic products, as well as promoting good reporting behavior.

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 …

Graduate Medical Education Graduation And Awards Ceremony, Philadelphia (2020), Philadelphia College Of Osteopathic Medicine

Commencements

Philadelphia Campus Graduation and Awards Ceremony program, 2020. Intern and resident specialties include Family Medicine, General Surgery, Internal Medicine, Neuromusculoskeletal Medicine/Osteopathic Manipulative Medicine, Neurosurgery, Ophthalmology, Orthopaedic Surgery, Otolaryngology/Facial Plastic Surgery, Plastic and Reconstructive Surgery, and Transitional Year.

Behind The Scenes Of Starting A New Residency Program, Traci Wooden, Krystal D. Hernandez, Elizabeth Rashid

Medical Education

During this workshop, we will split up the stages of building a new program into the following- Stage 1, Stage 2 and Stage 3. Stage 1 will focus on applying for initial accreditation, gathering faculty and sites, the first recruitment season, building/creating a curriculum, program planning and the first full cycle of GME including match, onboarding, orientation, CCC/PEC, wellness and more. Stage 2 will focus on more program planning, including building a new clinic, building electives, adding faculty, faculty development, continued accreditation site visit, building a senior curriculum and chief resident selection. Stage 3 will discuss board prep and board …

The Role Of Mindset, Impostorism, And Irrational Beliefs In Resident Wellness: Results From The Hca Nationwide Longitudinal Resident Wellness Study, Gregory Guldner, Jason Siegel, Brendon Ellis, Anne Brafford

Medical Education

Background The significant proportion of residents reporting poor levels of well-being has appropriately fueled a call for interventions. Yet the specific constructs that impact well-being have not been well researched and validated in the resident population. Mindset (fixed versus growth), impostorism (the belief that one’s success is fraudulent) and irrational beliefs (dysfunctional beliefs that contribute to emotional pain and anguish) are among individual variables postulated to relate to well-being in a high-pressure educational environment. Each of these constructs is amenable to interventions should they have causal relationships to well-being.

Objectives Our prior research resulted in a statistically validated model of …

Development Of A Graduate Medical Education Program In Obstetrics And Gynecology In A Community-Based Hospital: Building Blocks And Rate Of Progress, Parker B. Long, Katherine M. Choi Md, Rachael Postlethwait Md, Mohamed Foda Md, Karen Harris Md

OB-GYN

Synopsis

The need for trained obstetricians and gynecologists continues to increase. The ongoing advances in women’s health care requires well trained physicians that can only be achieved by a well-structured residency program that provides a reliable training infrastructure while maintaining a patient centered care model according AGCME standards. This residency program started July 2018 with 4 PGY1 and one PGY2 residents.

Objective

To prospectively look at the rate of growth needed to begin an OBGYN residency program in a community-based hospital.

Methods

For this particular residency program, we started a new OBGYN medical practice and all residents were involved in …

Obstetric Training In The Southeast Us: A 2019 Cera Study, Julia Fashner, Christy Cavanagh, Aimee Eden

OB-GYN

Purpose: To describe obstetric training in Southeast family medicine residencies in 2019. To determine factors that contribute to continuity deliveries, vaginal deliveries and residents who continue OB after graduation.

Methods: A survey of family medicine program directors was conducted in 2019. We took the answers from the 32 South Atlantic program directors that completed the survey questions of interest. We used chi-square tests and Kruskal-Wallis rank test to compare variables. STATA 14 was used for analysis.

Results: Half of the programs had graduates with10% of graduates continue OB after graduation. The following factors were significant for graduates who continue OB: …

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.

Can Our Hearts Take The New Guidelines?, Eitan Frankel, Md

The Medicine Forum

No abstract provided.

Resident Experiences With Journaling, Tara Sunder, Md, Gretchen Diemer, Md, Vikas Sunder, Md

The Medicine Forum

Background

Each year, medical school graduates don their long white coat for the first time and begin their residency. While residency promises the excitement of learning and increased autonomy, it also brings long duty hours and stressful situations worsened by inexperience. Due to these stressors, burnout affects many residents each year. Studies have been done to see if wellness curricula help decrease resident burnout, and since journaling is a known way to relieve stress and enhance reflection, journaling has become a common intervention in these curricula.1,2 While there are studies evaluating the impact of journaling on mental health and stress …

Pneumatosis Intestinalis In A Patient With Systemic Lupus Erythematosus, Sean Dikdan, Md, Michael Lake, Md

The Medicine Forum

Introduction

Pneumatosis intestinalis (PI) refers to the radiographic finding of gas within the small or large bowel wall. It can be seen in association with gas in the portal venous system. The clinical significance of these findings is variable and depends on the patient's etiology and initial presentation. PI can be seen anywhere in the gastrointestinal tract distal to the stomach and is caused by a myriad of conditions.1 We present a case of a patient admitted to the intensive care unit with PI and portal vein gas.

Hemothorax And Hemorrhagic Ascites: A Rare Presentation Of Endometriosis, Harry Wang, Md

The Medicine Forum

Introduction

Endometriosis is a common diagnosis in reproductive age women characterized by the presence of endometrial tissue outside the uterine cavity.1 Although it is typically confined to the pelvis, rare manifestations involving the thorax, abdomen or pericardium have been documented.2-5 Even more rare is the concurrent presence of endometriosis- associated hemorrhagic pleural effusion and ascites, which can prove a diagnostic challenge. We describe a case of hemothorax and hemorrhagic ascites in a woman with shortness of breath and abdominal pain.

Subacute Onset Hand Clumsiness In A Renal Transplant Patient With A Recent Icu Stay, William Bradford, Md

The Medicine Forum

Introduction

Solid organ transplant recipients carry a high burden of disease and are susceptible to opportunistic infections not seen in other patient subgroups. Signs and symptoms that would not necessarily warrant timely attention in other patient groups may call for an aggressive workup in this subset of patients. Here, we present one case in which a seemingly trivial complaint denoted serious underlying pathology, and timely attention to this minor but unusual concern led to early intervention with appropriate treatment of an uncommon disorder.

Hyperviscosity In Non-Igm Lymphoplasmacytic Lymphoma, Mario Fonseca-Paricio, Md, Sushil Chmire, Md, Adam Binder, Md

The Medicine Forum

The following is a case of how a non-IgM paraproteinemia can present with symptoms of hyperviscosity and coagulopathy, an uncommon occurrence.1-3 As this case demonstrates, this diagnosis must be considered even in patients with relatively normal coagulation laboratory results. Such pathology requires urgent treatment with plasmapheresis.

Worsening Autoimmune Neutropenia After Stopping Ibrutinib In A Patient With Chronic Lymphocytic Leukemia: Case Report And Review Of Literature, Natalie Rosen, Ba, Thomas Klumpp, Md, Sameh Gaballa, Md, Msc

The Medicine Forum

Introduction

Autoimmune cytopenia (AIC) is relatively common in patients with chronic lymphocytic leukemia occurring in 5-10% of patients during the course of their disease.1 Autoimmune hemolytic anemia (AIHA) constitutes the highest prevalence (5-10%) of CLL-associated AIC followed by idiopathic thrombocytopenic purpura (ITP) (2-5%), pure red cell aplasia (PRCA) (<1%), and autoimmune neutropenia (AIN) (<1%).2,3 The prevalence of AIN, however, may in fact be higher than reported due to a lack of awareness of the condition and difficulty in its diagnosis.4 Despite its rarity, autoimmune neutropenia can be a significant clinical challenge in patients with CLL and can increase the risk of infectious complications. Thus, the prompt diagnosis and resolution of CLL-associated AIN is essential to the management of these patients.

Ibrutinib is a selective inhibitor of Bruton tyrosine kinase and induces a durable response in patients with CLL.5 The activity of ibrutinib in CLL-associated AIC is largely unknown as pivotal clinical trials excluded patients with AIC. We report a case of a patient with CLL who experienced worsening of AIN after …

Bilateral Choroidal Metastases As Initial Presentation Of Widespread Follicular Thyroid Cancer, Jennifer Hong, Md

The Medicine Forum

Introduction

Follicular thyroid cancer (FTC) is the second most common malignancy of the thyroid gland and comprise 10-15% of all thyroid tumors; the usual mode of spread is via hematogenous dissemination with the most common sites of metastases being the lungs and bones.4 A case is presented to demonstrate the unusual presentation of follicular thyroid cancer as bilateral choroidal metastases. Although exceptional, a diagnosis of choroidal metastases should be considered in any decline in visual acuity in patients with thyroid cancer.

Complicated Persistent Peritonitis, Lindsey Roth, Ba, Kumar Sarkar, Md

The Medicine Forum

Introduction

Spontaneous bacterial peritonitis (SBP) is a common complication of end-stage liver disease. SBP can present with many symptoms such as abdominal pain, fever and altered mental status.1 The diagnosis of SBP is made when ascitic fluid from a paracentesis has an absolute neutrophil count (ANC) more than 250/uL, there is a positive ascitic fluid culture, and no secondary source of infection can be idenitifed.2 However, nearly 60% of patients with SBP have negative fluid cultures.3 These patients can still potentially have SBP and should be treated as such since in-hospital mortality ranges from 20-40%.1,4 Conventional treatment for SBP includes …

Sealing The Diagnosis Of Celiac Disease In Pregnancy, Ritu Nahar, Md, Avani Aman, Md

The Medicine Forum

Introduction

Celiac disease (CD) is an immune mediated condition that results from a reaction to dietary gluten and primarily affects the small intestine. Genetically predisposed individuals develop a chronic inflammatory state of the small intestine which leads to malabsorption. The disease is mediated by HLA DQ2 or DQ8 haplotypes, which bind the gliadin peptides of gluten, present the peptides to CD4+ T lymphocytes and trigger cytokine and B lymphocyte responses.1

The prevalence of CD in the United States is approximately 1% and can reach up to 4-5% in at-risk groups.2 Serologic study of asymptomatic elderly patients in the United Kingdom …

Thyrotoxic Periodic Paralysis – A Case Report Of A Rare Cause Of Paralysis In A 39-Year-Old Asian Man, R. Benson Jones, Md, James Uricheck, Md

The Medicine Forum

Introduction

Uncontrolled hyper thyroidism has a myriad of presentations. Classically, symptoms include weight loss, tremor, palpitations, shortness of breath, diarrhea, anxiety, and heat intolerance. A rare manifestation of hyperthyroidism is thyrotoxic periodic paralysis (TPP). Periodic paralysis is a musculoskeletal channelopathy manifested by episodes of painless muscle weakness often precipitated by heavy exercise, fasting, or high carbohydrate meals. Although classically associated with painless weakness; cramping, myalgias, and stiffness can also occur prior to the episodes as prodromal symptoms. Neurologic examination during an attack typically demonstrates proximal more than distal muscle weakness, and the upper extremities are more commonly affected than the …

A Case Report Of Pseudohypoglycemia In A Patient With Leukocytosis, Michael Weintraub, Md, Deepika Nandiraju, Md, Monika Shirodkar, Md

The Medicine Forum

Introduction

Hypoglycemia is most convincingly documented by Whipple’s triad: low plasma glucose, symptoms of hypoglycemia and relief of symptoms after treatment.1 Pseudohypoglycemia is a condition where there is an artifactually low glucose concentration and an absence of hypoglycemic symptoms. We present a case of pseudohypoglycemia where leukocytosis played a role in lowering venous glucose.

A Case Of Left Ventricular Myocardial Calcification In A Patient With Severe Sepsis, Carly Sedlock, Md, Randi Zukas, Md, Hillary Landon, Md

The Medicine Forum

Introduction

Sepsis is an important source of morbidity and mortality among patients admitted to the Intensive Care Unit (ICU) and can cause critical damage to all organ systems. Regarding cardiac complications, sepsis can acutely result in cardiomyopathy characterized by ventricular dilatation and a depressed ejection fraction.1 Myocardial calcification is a more rare, delayed cardiac complication of severe sepsis that has been reported in literature.1-6 Herein we report a case of a patient with Acute Myeloid Leukemia (AML) admitted to the TJUH ICU requiring prolonged vasopressor support for severe sepsis whose clinical course was complicated by left ventricular myocardial calcification.

Fibrous Web In The Right Atrium: A Complication Of Fungal Endocarditis And Previous Lead Infections, Harry Wang, Md

The Medicine Forum

A 57-year-old woman with a past medical history of severe non-ischemic cardiomyopathy undergoing orthotopic heart transplant evaluation on milrinone, prior extraction of multiple pacemaker and implantable cardioverter defibrillator (ICD) leads due to Staphylococcus epidermidis endocarditis, and multiple central venous catheter infections presented with several days of worsening dyspnea on exertion, orthopnea and lower extremity edema, prompting admission for congestive heart failure exacerbation.