Medical Specialties Commons^™

A Contemporary Guide To An International Aortic Super-Fellowship For Surgical Trainees And Surgeons In The United States, Roberto G. Aru, Adam W. Beck, Stéphan Haulon

Department of Surgery Faculty Papers

Fenestrated and branched technology for endovascular aortic repair of the thoracoabdominal aorta and aortic arch has evolved significantly over the last decade. The spectrum of these devices is largely available outside the United States (US), while patient-specific company manufactured devices are limited to ten sites in the US, with ongoing expanding use of market-approved off-the-shelf devices. The necessary environment for appropriate education to ensure safe dissemination of these technologies is limited, and the current centralization of both device availability and skillsets affects trainee education. In order to refine their endovascular treatment algorithm and planning/implantation skillsets at these multidisciplinary aortic centers, …

A Week-Long Departmental Scholarship Curriculum For Pediatric Subspecialty Fellows, Amy Creel, Amanda Messer, Robin English

School of Medicine Faculty Publications

BACKGROUND: Scholarly activity is a key requirement in pediatric subspecialty fellowship training. However, clear guidance on how to effectively support fellows in their scholarly endeavors remains limited. OBJECTIVE: This study assesses the impact of a week-long departmental scholarship curriculum designed to enhance fellows' research competencies. METHODS: In 2024, a curriculum was designed and delivered to first-year pediatric subspecialty fellows over 5 days, combining group learning sessions with individualized tasks. Pre- and post-curriculum surveys assessed fellows' confidence and knowledge across key scholarly domains. Daily session evaluations provided additional feedback. Fourteen fellows from 9 pediatric subspecialty programs participated. RESULTS: All first-year fellows …

Development Of A Longitudinal, Small-Group Pocus Curriculum For Internal Medicine Residents, Shah N. Mahmud Do, Ammar W. Bhatti Do, Ariq Rahman Md, Omar Al Qassab Md, Fraser Mackay Md

The Lahey Journal

Development of a Longitudinal, Small-Group POCUS Curriculum for Internal Medicine Residents

Introduction

Point-of-Care Ultrasound (POCUS) is integral for clinicians to enhance their diagnostic and procedural skills. Unlike Emergency Medicine or Anesthesia training programs, Internal Medicine programs often lack a structured and standardized curriculum. We thus developed a longitudinal and multi-pronged POCUS curriculum aimed at building trainee competency when utilizing ultrasound for diagnostic and procedural work-up.

Methods

The curriculum encompasses the following: basics of ultrasound, ultrasound-guided procedures, thoracic ultrasound/Bed Lung Ultrasound in Emergency (BLUE), and cardiac ultrasound/Focus-Assessed Transthoracic Echocardiography (FATE). These modules were integrated into the residents’ clinic blocks. We utilized …

Psych Assessment In The Er, Bailey J. Thompson, Addie Cowger, Hailie Hollis

Scholars Week

An immense amount of patients who enter the emergency department, whether for a psychiatric illness or not, struggle with mental health challenges. By creating a standardized routine and checklists for the care of high-risk psychiatric patients, the new quality and consistency can enhance patient experiences. This process will start at the triage stage and continue throughout their stay. Presenting the supportive research to the emergency department staff and introducing these changes gradually will help with staff buy-in and become a more sustainable process. Finally, with a structured approach, psychiatric patient outcomes will benefit significantly.

Rare Case Of Visual Hallucinations In A 60-Year-Old Female With A Recurring Pituitary Macroadenoma, Angelica Alday, Farah Qureshi, Kayvan Mirhadi

Advances in Clinical Medical Research and Healthcare Delivery

Pituitary adenomas are the third most frequently occurring primary intracranial tumor and are benign neoplasms that can have profound clinical implications. While most of these masses cause hormone hypersecretion, they may also be clinically silent until they elicit symptoms of mass effect, including severe headaches and visual field defects such as bitemporal hemianopia. This report highlights an atypical presentation of a pituitary adenoma that could be valuable for internists to consider when forming a differential diagnosis for patients with hallucinations. We discuss a case of a 60-year-old woman with a recent history of multiple emergency department visits for ongoing urinary …

Upper Respiratory Tract Infection Leading To A New Diagnosis Of Sweet Syndrome And Monoclonal Gammopathy Of Unknown Significance, Nidhi Rawat, Meron Gebrehiwot, Jason Raw, Jeyaprakash Ramachandran

HCA Healthcare Journal of Medicine

Background

We present a rare case of Sweet syndrome with underlying monoclonal gammopathy of unknown significance (MGUS) which initially presented as upper respiratory tract infection.

Case Presentation

A 52-year-old woman presented with a complaint of sore throat for 6 days, productive cough and fever for 5 days, and red, pruritic, circular, tender rashes on face, arms and trunk for 2 days. There was a past history of similar self-limiting rashes presenting intermittently for 1.5 years. She also reported to be taking tablet ibuprofen, as required for the past 1-2 years, for cervical spondylosis. On integumentary examination, widespread, red, tender, annular …

Does Cognitive Frame Affect Clinical Reasoning Among Medical Students? A Cross-Sectional Study, Xiao C. Zhang, Sara A. Belko, Andrew J Monick

Department of Emergency Medicine Faculty Papers

Background Diagnostic errors affect patient safety and lead to high costs. Cognitive bias is a key source of diagnostic error, and the framing effect poses a particular clinical challenge. The extent to which individual factors affect susceptibility to the framing bias is unclear, and the role of expertise in particular is contested across the literature. Objectives This study investigated the effects of framing bias on diagnostic reasoning among medical students. We hypothesised that the effects attributable to framing would be mediated by the number of years of medical education completed. Methods Participants were randomly assigned on an automated basis with …

A Cancer Haiku Triptych, Larry C. Driver

Advances in Cancer Education and Quality Improvement

This trio of patient-inspired Haiku attempts to capture the joyful optimism of cancer-free life in the first pair of spring and summer, with a hint of transition in the second, and the final autumn into winter piece heralding the realization that smoldering cancer has flared-up with the possibility of the end of life.

Streamlining Nuclear Theranostic Clinic Workflow, Charisma Desai, Anne Fisher

Advances in Cancer Education and Quality Improvement

Nuclear medicine clinic needs have drastically changed with the emergence of theranostics, exciting new agents in the fight against cancer. However, administering these agents is a resource-intensive task, increasing demand for physician consultation time with patients, clinic office space, and scanner time. We examined our institution’s nuclear medicine clinic workflow and interviewed the clinic’s front desk staff, technologists, nurses, managers, physicians, and patients to find sources of delays, dissatisfaction, and decreased efficiency. An Ishikawa diagram and decision matrix helped us determine the most impactful intervention with our available resources. For this cycle, we focused on the consent process. Theranostic patients …

Impact Of Clinical Decision Support Tool Implementation On Injectable Calcitonin Usage, Petar Jordanov, Ashley Crouch, William Towers

Advances in Cancer Education and Quality Improvement

Calcitonin injection is a high-cost medication used to treat hypercalcemia in hospitalized patients. Many institutions have implemented strategies to reduce unnecessary use or waste of calcitonin, including dose rounding, formulary restriction criteria, and limiting the number of doses a patient may receive. MD Anderson Cancer Center (MDACC) utilizes approximately 1200 calcitonin doses per year with no current formulary or dosing restriction criteria. The goal of this study was to evaluate patterns of use of calcitonin at MDACC and implement and evaluate the impact of clinical decision support tools to reduce unnecessary calcitonin use and waste. This is a single-center quality …

Interactive Clinical Dashboard For Psychiatric Oncology Services At A Cancer Institution: A Quality Initiative, Maria Shabih, Adelita D. Martinez, Alan D. Valentine, Deepti A. Chopra

Advances in Cancer Education and Quality Improvement

Accurate documentation of reasons for psychiatry consultations is critical for developing an effective treatment plan for the patient and improving quality of care through targeted interventions. The purpose of this project was to create an interactive dashboard on Power BI. We downloaded the report from Epic on SAP BI. On an Excel sheet, we recoded the reason for consults and categorized using a keyword list and recoded the consults into distinct, categories such as "anxiety," "depression," and "altered mental status (AMS)," with data spanning 2 fiscal years.

Key findings from the dashboard revealed that anxiety and depression accounted for most …

Designing An Electronic Patient-Reported Outcomes Information Infrastructure Supported By The Re-Aim Implementation Framework, Amy C. Moreno, Angela Peek, Toshiko S. Stein, Kevin R. Shook, Sara M. Ali, Laia Humbert-Vidan, Aileen Chen, Miriam Lango, Anna Lee, Michael Spiotto, William H. Morrison, Adam S. Garden, Jack Phan, Steven J. Frank, Katherine Hutcheson, David I. Rosenthal, Clifton D. Fuller, G Brandon Gunn

Advances in Cancer Education and Quality Improvement

Objective: Patient-reported outcomes (PROs) contain valuable information that can be leveraged by providers to perform timely interventions and improve quality of life and survival. However, the implementation of electronic PROs (ePROs) remains a challenge from technical and evaluation perspectives. Our objective was to construct a robust electronic health record (EHR)-integrated ePRO information infrastructure founded on RE-AIM (reach-effectiveness-adoption-implementation-maintenance) principles.

Materials and Methods: We used Epic Systems as our EHR platform to build the MD Anderson Symptom Index Head and Neck Module (MDASI-HN) for release to all patients undergoing evaluation and/or treatment in our HN Radiation Oncology clinics. RE-AIM metrics were …

Clinical Instructors In Gynecologic Oncology: Addressing Gaps In Cancer-Related Care And Gynecology Training Deficiencies, Sadhvi Batra, Ann Marie Mercier, Robert Wenham

Advances in Cancer Education and Quality Improvement

The shift toward minimally invasive techniques and sub-specialization in gynecology has reduced generalist surgical experience, prompting new training roles to better manage complex benign conditions and cancer survivorship.

The Use Of Firgun To Improve Burnout And Workplace Civility In A Pediatric Cancer Center, Karen Moody, Jerry Stein, Deena Levine, Arshia Madni, Clark R. Andersen, Amy Heaton, Alakh P. Rajan, Demetrios Petropoulos, Jian Wang, Deborah Kramer

Advances in Cancer Education and Quality Improvement

Burnout afflicts 35% to 44% of pediatric oncology physicians, nurses, and interprofessional staff and is related to excessive workloads and emotional exhaustion. Conversely, a healthy work environment is a protective factor for burnout among physicians and nurses. Meaningful recognition is a published standard necessary for creating a healthy work environment. This study aimed to reduce staff burnout through firgun, defined as a heartfelt way to express accomplishments of another person. Pediatric oncology staff completed a firgun educational module and logged acts of firgun during a 3-month study period. Validated measures assessing burnout, workplace civility, well-being, work-life balance, and perceived …

Perspectives On High-Value Care Education Among Us Medical Students, Hannah K. Bassett, Michelle Chen, Shivani Jain, Anitra Karthic, Karthik Ramesh, Hannah Shenton, September Wallingford, Allison Heacock

School of Medicine Faculty Publications

No abstract provided.

Perceived Gaps In Preparation For Pathology Residency And Opportunities For Improvement, Barbara Knollmann-Ritschel, Julie Karp, Stephanie Barak, John Childs, Kristen Johnson, Amanda Lofgreen, Mary Berg, Satyapal Chahar, Hailey Gosnell, Cindy Mccloskey, Balaram Puligandla, Kristie White, Bronwyn Bryant

Department of Pathology, Anatomy, and Cell Biology Faculty Papers

The transition from medical school to residency is both a transformative and a challenging process. International literature suggests that there are known or perceived gaps in preparation for residency training in many areas of medicine. However, in the current published literature, there is no discussion of perceived gaps existing in pathology residency preparation. This study surveyed both pathology residency program directors and first-year pathology residents about the knowledge of pathology and basic medical skills residents received in medical school, perceptions about readiness for pathology residency, and perceived gaps in preparation for pathology residency that could be addressed. This survey found …

A Structured, Competency-Based Framework For Aspiring Cardiothoracic Surgeons, Adham Ahmed, Samantha Colon, Gianna J. Dafflisio, Purab Kothari, Nina Uzoigwe, Alice Zhou, Juli Buchwald, Betemariam Sharew, Carter Glenn, Steven Medvedovsky, Justin Olivera, Ryan Kramer, Gabrielle Colon, Jonathan M. Tomasko, Sara J. Pereira, Mara Antonoff, Marc Pelletier, Irbaz Hameed

Student Papers, Posters & Projects

OBJECTIVE: Cardiothoracic surgery requires mastery of a broad knowledge base and advanced skillset to manage critically ill patients. Although competency-based assessment frameworks have been developed in several specialties, there remains a paucity of resources to guide practical progression for early cardiothoracic surgical trainees.

METHODS: Members of the Thoracic Surgery Residents Association, Thoracic Surgery Medical Student Association, and attending cardiothoracic surgeons with a strong track record of surgical education were invited to share their insights and experiences. A structured, milestone-driven roadmap was developed on the basis of their contributions.

RESULTS: We developed a structured, competency-based framework for early surgical trainees, with …

Association Between End-Of-Third-Year Objective Structured Clinical Examinations And Accreditation Council For Graduate Medical Education Milestones During Intern Year, Katherine Berg, Jillian Zavodnick, Dianna Cheney-Peters, Heather Heiman, Sally Santen, Yoon Soo Park, Anita Wilson

Department of Medicine Faculty Papers

BACKGROUND: The Objective Structured Clinical Examinations (OSCEs) administered in medical schools have increased in importance with the elimination of United States Medical Licensing Exam (USMLE) Step 2 Clinical Skills (CS).

OBJECTIVE: The purpose of this study was to understand the association between student performance on an end-of-third-year OSCE and performance in residency.

METHODS: This study explored the correlations between OSCE performance and relevant Accreditation Council for Graduate Medical Education (ACGME) milestone 1.0 performance. This study included students’ scores from 139 Sidney Kimmel Medical College (SKMC) students who completed an end-of-third-year OSCE during 2015 and 2016 and completed an intern year …

Developing Empathy In Paramedic Students Using Didactic And Deliberate Practice Education Programs: A Mixed-Methods Study, Nick J. Waltrich, Jade Sheen Phd, Mathew Ling, Melissa O'Shea

Internet Journal of Allied Health Sciences and Practice

Purpose: Paramedics often attend to patients presenting with a mental illness, however research suggests paramedics have difficulties when attending to this patient cohort. Conversely, clinical psychologists receive training that focuses on developing strong therapeutic relationships with their patients through the use of empathy. As research has highlighted that paramedic students are known to demonstrate low levels of empathy, this study aimed to investigate the utility of two education methods used in clinical psychology training, didactic teaching and deliberate practice (DP), to develop the skill of empathy in paramedic students. Method: Students currently enrolled in an Australian paramedic university degree were …

Educating Future Nurse Practitioners And Physician Associates On Pretreatment Of Swallowing In Head And Neck Cancer, Hannah M. Berk, Erin L. O'Bryan, Imran Musaji, Carly A. Thomas, Jamie Harrington

Teaching and Learning in Communication Sciences & Disorders

Head and neck cancer treatment frequently results in long-term severe swallowing deficits, often requiring feeding tube dependency. Patients who have completed swallowing exercise programs before and during cancer treatment experienced more positive swallowing outcomes, but most patients are not referred for swallowing intervention early enough in their care to prevent long-term deficits. This student research project aimed to measure health profession students’ knowledge of swallowing pretreatment for head and neck cancer patients and to investigate the impact of an educational module developed and presented by a Communication Sciences and Disorders graduate student to improve knowledge and awareness of this clinical …

Orthostatic Hypotension In Older Adults And Its Economic Impact On The Healthcare System: A Systematic Literature Review, Olushola E. Ilogho, Jennifer Broyles, Viet Le, Denise Rizzolo

Lynchburg Journal of Medical Science

ABSTRACT

Orthostatic Hypotension (OH) has been shown to lead to poor quality of life, falls, and death. Literature suggests that falls from OH may be preventable, therefore opportunities to reduce its associated cost to the healthcare system exist. This literature review aims to evaluate the importance of diagnosing and treating OH in older adult patients. OH is the drop in blood pressure upon changing to an upright position. This acute hemodynamic drop in blood pressure causes hypoperfusion in the brain, leading to dizziness, syncope, and falls. An extensive literature search for publications in PubMed and Cumulative Index in Nursing and …

America's Physician Shortage: Look To Pas, Not Abroad, Raquelle Akavan, Laura Juarez

Lynchburg Journal of Medical Science

The United States has long addressed physician shortages by recruiting international medical graduates (IMGs), often from low- and- middle income countries. This "brain drain" deprives already fragile health systems and adds to worldwide health disparities. New state legislation has eased licensing standards for IMGs and generated variable training pathways creating patient safety risk in underserved groups. At the same time, the U.S. has a sustainable, highly trained, and proven ready workforce: physician associates (PA). Created in the 1960s to address physician shortages, PAs undergo intensive graduate-degree education, uniform clinical education, and national certification on par with physicians. Nonetheless, obsolete laws …

Two-Staged Lateral Based Thenar Flap For Fingertip Injuries Of Index And Middle Fingers –A Functional Outcome, Srinivas Pamarthi, Pooja Mannela, Saiphanindra Malladhi

Digital Journal of Clinical Medicine

Introduction:

Fingertip injuries, particularly of the index and middle fingers, account for major accidents which occur in industrial regions due to machinery usage, causing sharp cuts or crush injuries of the tips. The treatment of these fingertip injuries previously was amputation and stump closure. As the advancement of flaps occurred, there came many flaps mentioned to treat these tip injuries. Many of these flaps had failed to provide the same functional and aesthetic outcome following surgery. This study aims at assessing laterally-based thenar flap for tip injuries of index and middle fingers for its aesthetic and functional outcome.

Methods:

This …

The Rash After The Remedy, Elaine Chen, Nicholas Nelson

Abstracts, Posters, Presentations

No abstract provided.

Soft Tissue Envelope Compromise Following Low-Side Motorcycle Accident: A Case Study And Literature Review, Steven A. Bolton, Ali Ahmad, Jonathan Rodriguez, Hooman Mir

School of Podiatric Medicine - Student Research

Purpose: This case report details a staged approach in managing a patient who presented to the ER with a displaced proximal second phalanx fracture, extensive soft tissue damage, and diffuse fracture blistering following a motorcycle crash. This case highlights that soft tissue damage may not always correlate with severe osseous injury.

Methodology: This case is a concurrent chart review of a 40-year-old who sustained a low side motorcycle injury resulting in a minimally displaced avulsion fracture of the medial 2nd toe proximal phalanx base with extensive soft tissue damage, fracture blisters, and lower extremity edema.

Procedures: Radiographic evaluation demonstrated no …

Teaching Ai For Radiology Applications: A Multisociety‑Recommended Syllabus From The Aapm, Acr, Rsna, And Siim, Felipe Kitamura, Timothy Kline, Daniel Warren, Linda Moy, Roxana Daneshjou, Farhad Maleki, Igor Santos, Judy Gichoya, Walter Wiggins, Brian Bialecki, Kevin O’Donnell, Adam Flanders, Matt Morgan, Nabile Safdar, Katherine P. Andriole, Raym Geis, Bibb Allen, Keith Dreyer, Matt Lungren, Monica J. Wood, Marc Kohli, Steve Langer, George Shih, Eduardo Farina, Charles E. Kahn Jr., Ingrid Reiser, Maryellen Giger, Christoph Wald, John Mongan, Tessa Cook, Neil Tenenholtz

Department of Radiology Faculty Papers

No abstract provided.

Undifferentiated Embryonal Sarcoma Of Liver In A Child : A Case Report, Neha Devendra Bhongale, Sumeet Baheti, Poonam Wade, Omkar Khandkar, Meenakshi Balasbramanian

Digital Journal of Clinical Medicine

Background: Undifferentiated Embryonal Sarcoma of liver (UESL) is a rare malignancy of liver originating from primary mesenchymal tissue with overall poor prognosis. Around 220 pediatric cases of UESL have been reported in the literature. The lack of characteristic clinical manifestations, laboratory tests and imaging studies pose a diagnostic challenge and the preoperative misdiagnosis rate is high. Historically, treatment was limited to surgical resection with poor survival rate. In recent times, combination of chemotherapy and surgical resection has improved survival.

Case Presentation: We report a case of undifferentiated embryonal sarcoma of liver in a 6 years old boy who presented …

Urology Resident Associate: A Promising Alternative For The Unmatched Urology Applicant, Jayson Kemble, Grace Handleman, Chad A. Lagrange, Christopher M. Deibert

Graduate Medical Education Research Journal

Background. Demand for urology residency spots frequently outstrips supply, with unmatched urology applicants having limited options while waiting for reapplication. We aim to demonstrate our experience with a year-long Urology Resident Associate (URA) position, which merges the role of junior resident and APP with the mission to reduce resident workload and further the training of an unmatched urology applicant.

Methods. A year-long, non-Accreditation Council for Graduate Medical Education (ACGME) accredited URA position was created at our institution in 2023 and filled by an unmatched applicant to our program. The URA was given all the roles and responsibilities of a …

Dermatology Match Disparities: Analyzing Osteopathic Vs. Allopathic Student Outcomes Post-Acgme/Aoa Single Accreditation System (2020-2024)., Leo Wan, Karandeep Bawa, Aileen Park, Haaris Kadri, Austin Cusick, Shannon C Trotter

Medical Education Articles

CONTEXT: Dermatology remains one of the most competitive medical specialties, with successful candidates often demonstrating outstanding academic performance, extensive research experience, and strong letters of recommendation. The integration of the Accreditation Council for Graduate Medical Education (ACGME) and the American Osteopathic Association (AOA) into a single accreditation system in 2020 was intended to streamline residency training, but it has raised concerns about how Doctor of Osteopathic Medicine (DO) applicants will perform in dermatology residency match.

OBJECTIVES: This study examines the differences in DO and MD match rates following the single graduate medical education (GME) accreditation system, focusing on the match …

From Imaging To Impact: A Multi-Disciplinary T32 Program Framework And Initial Insights For Training In Image-Guided Cancer Therapy, Kari J. Brewer Savannah, Stephen Y. Lai, Clifton D. Fuller, Kristy K. Brock

Advances in Cancer Education and Quality Improvement

As multi-disciplinary image-guided assessment and therapies become increasingly important for precision oncology, the need for comprehensive training opportunities that effectively prepare the next generation of clinician-scientists and scientists is evident. We present an innovative, evidence-based research training framework that integrates the following critical features: 1) intentional and personalized mentoring and career development, 2) immersive research in image-guided cancer therapy, 3) strategic mentored clinical exposure, 4) structured didactic learning and professional development opportunities, and 5) mentored grant writing. Designed to foster scientific rigor, translational thinking, and multi-disciplinary collaboration, the Image-Guided Cancer Therapy T32 Training Program (IGCT-T32) aims to prepare postdoctoral fellows …