Purpose: Limited institutional resources exist for pregnant and parenting medical students; however, students' opinions regarding pregnancy in medical school have not been reported.The authors assessed medical students' perspectives regarding pregnant or parenting peers and underlying bias or resource gaps.Methods: An online, cross-sectional survey was distributed in October 2022 to medical students at Michigan State University College of Human Medicine (n = 806) to explore demographics, bias, family planning, and available resources.Descriptive analyses, a twotailed t-test comparing female and male responses, and a one-way analysis of variance test comparing medical school classes were used. Results:The survey response rate was 13.2% (n = 106).Few respondents (n = 4, 3.8%) had been pregnant during medical school.The majority (n = 67, 71.3%) indicated family plans influence specialty choice.Furthermore, 78.0% (n = 42) cited career and education as their reason for choosing to delay pregnancy.Other descriptive analyses identified that 80.0% (n = 75) of respondents were not aware of resources available for pregnant or parenting classmates.Also, 13.0% (n = 12) of respondents had witnessed bias toward a pregnant medical student.Differences in opinions between males and females were present regarding bias and support available.Differences between medical student classes also exist regarding opinions indicating pregnancy as a barrier during school.The statements with the strongest overall agreement were: Pregnant medical students are resilient, face additional challenges, and parental leave should be available in medical school. Conclusion:This study provides new information regarding pregnancy opinions in medical school and highlights pregnant medical students' challenges and biases.We revealed common delays in pregnancy due to career or educational choices and uncovered the strong consensus among students that parental leave should be an option.Support efforts are warranted to decrease biases and offer parental leave to promote equity and inclusion.
Background: Those experiencing homelessness face disproportionately large barriers in access to healthcare.Patient Navigation is a service that provides disadvantaged populations with guidance through healthcare systems.Acting as a patient navigator is found to help enhance learning in the pre-clinical years of medical school.Developed by medical students, the Patient Navigator Program (PNP) pairs medical students trained as patient navigators with individuals experiencing homelessness.The uniqueness of this program lies in its fully student-run format, simultaneously providing individuals experiencing homelessness with longitudinal navigation services toward self-defined goals and medical students with exposure to a disadvantaged and underserved population in their early years of medical school.The purpose of this study is to evaluate the growth and student experiences of PNP from its inception and inform those who aim to develop similar student-run patient navigation programs.Methods: Participation metrics in the program were extracted from volunteer records, and five 30-min student leader semi-structured interviews were conducted using open-ended questions to investigate the experiences of those who developed the program.Interviews were transcribed, and responses were categorized by themes.Results: Enduring involvement in PNP over years was demonstrated quantitatively through participation metrics and qualitatively through interviews.Positive aspects of participation in PNP were meeting and working with other students, utilizing their creative vision in developing the program, learning about those experiencing homelessness and the local resources available to them, shaping career goals and academic interests, and learning the soft skills necessary for medical clerkships.Negative experiences primarily revolved around time constraints of the program in addition to their academic responsibilities.Commonly stated advice included identifying an appropriate faculty mentor and building strong relationships with community partners.Conclusions: Participation in PNP was felt to be beneficial both personally and professionally.Reporting these perspectives and experiences will provide insight to future student-led programs at other institutions.
Dermatofibromas (DF) are small, noncancerous skin lesions typically found in the dermis layer of the skin and are often composed of a variable combination of inflammatory cells, which classically present as a firm, nonpainful, skin-colored nodule on the extremities or trunk.We present a case of a 53-year-old woman with a medical history of psoriasis who had bilateral leg swelling, erythema, and dry skin for which she underwent a punch biopsy of the left thigh.The punch biopsy sample was found to be a dermatofibroma, which was negative for malignancy or atypia.The skin rash and associated symptoms were due to Candida intertrigo, which was treated with broad-spectrum antibiotics and fluconazole.Following this, she was discharged and prescribed a course of fluconazole and linezolid for continued treatment of Candida intertrigo.This case report describes a rare presentation of benign dermatofibroma.
Background: The COVID-19 pandemic caused rapid uptake of telemedicine in primary care settings affecting cancer screening. Objective: This study aimed to understand provider perception of future cancer incidence and telehealth feasibility in cancer screening. Methods: Data were gathered and analyzed as part of the 2020 Council of Academic Family Medicine’s (CAFM) Educational Research Alliance (CERA) survey for primary analysis. The 2020 General Member COVID Survey examined demographics, the impact of faculty isolation, E-learning experience, cancer screening during COVID-19, and outpatient prenatal care. Survey participants were practicing family medicine physicians who were members of one of the CAFM organizations, with a response rate of 14.5%. Descriptive statistics were calculated. Analysis of Variance (ANOVA) was used to evaluate the relationship between telehealth sufficiency and provider age or year they earned their highest degree. Logistic regression evaluated the relationship between telehealth sufficiency and institution type. Results: 54% of respondents believe that there will be an increase in late-stage cancer. Respondents whose practice settings were not affiliated with medical schools were 1.94 times more likely to feel that telehealth would not be sufficient for cancer screenings in the future (odds ratio [OR] = 1.94, 95% confidence interval [CI]: 1.28, 2.93). Conclusion: While our study shows that in light of the COVID-19 pandemic, primary care physicians believe there will be an increase in later stage cancer; they can also use telehealth to adequately maintain cancer screening practices. This research serves as a starting point to understanding where, in cancer screening, telehealth can be useful and how practitioners can provide high-quality hybrid care.
Background: Increased availability and use of cannabis in Michigan have led to a marked increase in emergency department (ED) visits associated with the drug's adverse cardiopulmonary effects.However, few people are aware of these potential cardiopulmonary side effects.Recognition of these presenting symptoms is critical for emergency clinicians to provide timely and effective care, make accurate diagnoses, and safeguard the health of patients who may be experiencing toxic effects from cannabis use. Study objective: To describe the prevalence, clinical features, and disposition of cannabis cardiopulmonary toxicity in a communitybased study.Methods: This was a retrospective cohort analysis of all patients diagnosed with toxicity related to cannabis use.Patients were seen at eight EDs over a 26-month study period (November 2018-December 2020).Affiliated institutions included three university-affiliated hospitals, a children's tertiary care facility, and four rural medical centers.Data collected included demographics, clinical features, and treatment outcomes in patients presenting to the ED with cardiopulmonary symptoms (CPS) versus those experiencing other forms of cannabis toxicity.Results: During the study period, 1,174 patients were evaluated for cannabis toxicity.A total of 318 patients (27.1%) had a cardiopulmonary chief complaint (CPS group) and 856 (72.9%) experienced other forms of cannabis toxicity, predominantly symptoms of intoxication, cannabis hyperemesis syndrome, or neuropsychiatric complaints.The CPS group presented with tachycardia (36.5%), dyspnea (34.3%), chest tightness (28.6%), palpitations (17.9%), and hypertension (8.2%).CPS patients were more likely to be older (32.6 vs. 24.3years, p < 0.001), ingested edible cannabis (36.8% vs. 9.2%, p < 0.001), and have a history of polysubstance abuse (17.6 vs. 12.0%, p = 0.013).These patients also had a longer ED length of stay (4.9 vs. 3.8 h, p < 0.001) and significantly more hospital admissions (10.1% vs. 6.3%, p = 0.027).Conclusions: Cardiopulmonary toxicity is common after acute or chronic cannabis exposures, occurring in over one-quarter of ED patients in this community-based study.These troublesome findings highlight the risks associated with using cannabis for recreational or therapeutic purposes.
Background: Optic neuritis (ON) is inflammation of the optic nerve that can occur in both adults and children.This disease is marked by a heterogeneous presentation in children and has clinical and epidemiologic characteristics that differ greatly from those found in adults.The purpose of this report is to illustrate the clinical features of ON that occur during childhood and to highlight the differences of ON in children versus adults.In doing so, we aim to add to the sparse current literature on this topic and help prevent the future misdiagnosis of ON in pediatric patients.Case Presentations: An 11-year-old female presented with bilateral decreased visual acuity and significant ocular pain.The ophthalmic presentation and diagnostic workup led to the diagnosis of acute disseminated encephalomyelitis with ON.A second patient, a 12-year-old male, presented with decreased visual acuity and bilateral papilledema.Alongside a diagnosis of bilateral ON, a muscle biopsy confirmed mitochondrial cytopathy as the etiology of his presenting symptoms.Conclusions: ON in children may be related to specific infections, autoimmune disorders, diseases of adjacent anatomical structures, or demyelinating disorders.Attacks may be acute or subacute with signs of reduced visual acuity, abnormal pupillary response, loss of color vision, impaired contrast sensitivity, and decreased peripheral vision.Awareness of this complex disease allows the clinician to initiate specific treatment and follow-up care that may reduce subsequent morbidity and the rate of recurrence.
Introduction: While some studies suggest probiotic supplements may prevent Gestational Diabetes Mellitus (GDM), it is unclear if probiotics effectively prevent GDM among overweight and obese patients. This systematic review synthesizes recommendations for clinical practice and future research by evaluating the quality of evidence regarding Lactobacillus and Bifidobacterium containing probiotics to prevent GDM among obese and overweight patients. Methods: PubMed, Embase, CINAHL, and Web of Science were searched using appropriate MeSH terms. Results were limited to randomized controlled trials published between 2011 and 2021. Titles and abstracts were screened for relevance after duplicates were removed. The inclusion criteria were as follows: studies that diagnosed GDM according to the International Association of Diabetes and Pregnancy Study Group criteria, suspended probiotic use prior to intervention, excluded participants with altered glucose metabolism, included participants with a body mass index ≥ 25 kg/m 2 , and provided a specified dose of probiotic supplements. Articles without statistical analysis were excluded. Resulting articles were critically appraised using Version 2 of the Cochrane Risk of Bias tool. Results: This search strategy resulted in 24 articles after duplicates were removed. Five double-blind randomized controlled trials found that the incidence of GDM during the third trimester was not significantly different between probiotic and control groups. There was wide variation in the bacterial species, dose, and duration of probiotic treatments used. All studies have a high risk of bias due to non-adherence to the treatment. Discussion: This review used highly sensitive criteria for GDM diagnosis that may mask a preventative effect of probiotics. Noncompliance may bias results toward the null, given insufficient analysis of the effect of adhering to the intervention. No patterns between the length of probiotic intervention or probiotic species and improved glucose tolerance were noted. Conclusions: Current evidence is not sufficient to recommend probiotic supplements to prevent GDM in overweight and obese patients. Future evidence should address the effect of adhering to probiotic interventions and develop consistent probiotic intervention protocols.
Purpose: Patient positioning plays a crucial role in the field of radiology.Lateral knee X-rays are a type of image that often has incorrect positioning of the angle of knee flexion.The ideal range is between 20 and 30 degrees.The goal of this study was to assess the angle of knee flexion at two different locations in a single hospital system while determining if several variables influence the angle.Method: This study is a retrospective chart review that assessed the angle of knee flexion in patients 18 years or older that underwent a lateral-mediolateral knee X-ray taken at an urgent care center and a general diagnostic center of a hospital within the same system between March 1 and December 1, 2021.Variables including age, sex, BMI, technologist, and location were collected from these patients' charts and evaluated.MRI information was gathered for patients who underwent an MRI within 30 days of a lateral knee X-ray.The research team assessed effusions reported on X-ray compared to effusions reported on MRI for these patients.Results: Among patients included in the study (n = 665) the average angle of knee flexion was 51.28 degrees.Age, sex, BMI, and location were not significantly associated with the mean angle of knee flexion with p-values of 0.63, 0.13, 0.55, and 0.15 respectively.The radiology technologist taking the image did have an association with the angle of knee flexion with a p-value of 0.001.Differences in the mean angle of knee flexion between the groups of X-rays with effusions reported compared to the groups of X-rays where effusions were not reported but found on MRI resulted in a p-value of 0.83. Conclusions:The technologist taking the image was the only variable of this study that had a significant difference in mean angle of knee flexion.Additional studies are needed to determine what technologist factors are most important in determining the angle of knee flexion.Using MRI information to evaluate if effusions were not reported due to the angle of knee flexion was limited in this study due to small sample size.
Diffusion-tensor imaging has become common practice in radiology and imaging research due to its many applications in brain connectivity and neurodevelopment as well as for pathologies including tumors, ischemia, trauma, and neurodegeneration.However, its novelty compared to other neuroimaging techniques has meant that graduate programs, particularly medical schools, have not included opportunities to learn how diffusion tensor imaging can visualize the brain and interpretation of the data clinically and in research.Diffusion tensor imaging can be a challenging utility to understand for newcomers and is subject to wide interpretation.We offer for medical and graduate students as well as residents a step-by-step guide in interpreting diffusion tensor imaging results for clinical analysis using simple explanations of physics and neuroscience and its application in clinical and translational research.
Background: Incoming emergency medicine residents may feel unsure of their ability to handle common emergency department scenarios, even if they are well educated on the proper steps to take in those scenarios.This may not stem from a lack of skill so much as a lack of confidence in their ability to perform with skills they have.Objective: We look to establish a link between completion of simulationbased training in common emergency medicine scenarios and learner self-reported confidence in their ability to perform competently in those scenarios.Methods: Fourth-year medical students who matched into an emergency medicine residency program participated in a Transitional Educational Program (TEP) at the Interprofessional Immersive Simulation Center at the University of Toledo in April 2021.Simulations of 16 procedural skills and clinical judgement cases were carried out using high-fidelity mannequins and real medical equipment in a hospital-based setting.Subjects were given pre-and post-TEP survey questionnaires assessing their self-reported confidence to competently perform in common emergency medicine clinical scenarios, using a 5-grade Likert scale.Data was analyzed using a one-tailed Wilcoxon signed-rank matched-pairs test.Results: Of 19 participating subjects, 16 (84.2%)consented and responded to the pre-survey.Of those 16 subjects, 10 (62.5%) completed the surveys at the correct time and order.The pre-and post-surveys consisted of the same 14 questions.In 11 of 14 survey questions, there was a significant increase in subject self-reported confidence (p<.05) between pre-and post-survey.Conclusions: Simulation-based training in the setting of high-fidelity equipment and faculty guidance improved the self-reported confidence of incoming emergency medicine residents to perform in common emergency medicine scenarios.
Purpose: Patient positioning plays a crucial role in the field of radiology.Lateral knee X-rays are a type of image that often has incorrect positioning of the angle of knee flexion.The ideal range is between 20 and 30 degrees.The goal of this study was to assess the angle of knee flexion at two different locations in a single hospital system while determining if several variables influence the angle.Method: This study is a retrospective chart review that assessed the angle of knee flexion in patients 18 years or older that underwent a lateral-mediolateral knee X-ray taken at an urgent care center and a general diagnostic center of a hospital within the same system between March 1 and December 1, 2021.Variables including age, sex, BMI, technologist, and location were collected from these patients' charts and evaluated.MRI information was gathered for patients who underwent an MRI within 30 days of a lateral knee X-ray.The research team assessed effusions reported on X-ray compared to effusions reported on MRI for these patients.Results: Among patients included in the study (n = 665) the average angle of knee flexion was 51.28 degrees.Age, sex, BMI, and location were not significantly associated with the mean angle of knee flexion with p-values of 0.63, 0.13, 0.55, and 0.15 respectively.The radiology technologist taking the image did have an association with the angle of knee flexion with a p-value of 0.001.Differences in the mean angle of knee flexion between the groups of X-rays with effusions reported compared to the groups of X-rays where effusions were not reported but found on MRI resulted in a p-value of 0.83. Conclusions:The technologist taking the image was the only variable of this study that had a significant difference in mean angle of knee flexion.Additional studies are needed to determine what technologist factors are most important in determining the angle of knee flexion.Using MRI information to evaluate if effusions were not reported due to the angle of knee flexion was limited in this study due to small sample size.
Background : The medical literature on vulvovaginal lacerations following consensual versus nonconsensual sexual intercourse is sparse and conflicting. Objectives : To compare the predisposing factors, injury location and severity, as well as treatment of vulvovaginal lacerations sustained during consensual versus nonconsensual sexual intercourse, in adult women within a community-based cohort. Methods : This is a retrospective comparative analysis of adult women presenting to the emergency departments of five hospitals and a free-standing nurse examiner clinic during a 7-year study period. All patients had documented vulvovaginal lacerations and reported vaginal penetration via consensual sexual intercourse (CSI) or nonconsensual sexual intercourse (NCSI) within 72 h of presentation. Results : A total of 598 cases were identified: 81 (14%) reported CSI, and 517 (87%) reported NCSI. CSI patients were younger (21.3 vs. 25.7, p < 0.001) and reported a greater incidence of penile penetration (97.5% vs. 75.9%, p < 0.001). While NCSI subjects had a higher incidence of vulvovaginal lacerations overall (1.7 vs. 1.0, p < 0.001), their injuries were smaller (1.1 cm vs. 4.3 cm, p < 0.001) and more likely to be located on the posterior vulva (83% vs. 69%, p = 0.003) when compared with the CSI group. In addition, all the lacerations in the NCSI group were superficial. In contrast, 27 (33%) of CSI subjects had lacerations sutured in the ED; 6 (7%) required aggressive fluid resuscitation and 10 (12%) required surgical intervention. Conclusions : In this community-based population, more severe vulvovaginal lacerations were noticed in women following CSI. The predisposing factors, injury location, and subsequent treatment in this group were significantly different when compared with women reporting NCSI.
INTRODUCTION: This study aims to assess the impact of various teaching methods including role play, didactic lectures, and case studies on the history taking and communication skills of second year Bachelor of Medicine and Surgery (MBBS) students.The goal is to help students become better doctors by arriving at diagnoses quicker through asking relevant questions in their history taking.A secondary goal is to improve the doctor-patient relationship through better communication skills.METHODS: The students were assessed on their history taking and communication skills before and after the application of specific teaching methods.The teaching methods were chosen according to efficacy and impact as shown by other research articles, in addition to the convenience of applying them to our study and the curriculum of similar schools.The improvement was scored by the faculty at KEM Hospital in Dubai, India, where the study was conducted, using a checklist which includes the main aspects of communication and general history taking.We tested the students on their communication skills, completeness of their history taking with regards to history of the presenting illness, history of past illnesses, personal history, family history, and mental status report.The results of the pre-and postintervention scores were analyzed using paired t-tests.RESULTS: Fifteen students were assessed in this study.The results showed improvement in their mean scores after the teaching methods were applied.Using the student t-test, we statistically analyzed the students pre-and post-intervention.The p-value was found to be statistically significant (<0.05) in communication skills, completeness of their history taking with regards to history of the presenting illness, history of past illnesses, family history, and mental status report.It was found to be nonsignificant with regards to personal history taking.CONCLUSIONS: The students benefited from the teaching sessions conducted during their surgical rotations.Applying these teaching tools helped students come to diagnoses better through history taking alone.Their communication skills were also found to be significantly improved, which has shown to positively impact physician-patient rapport and treatment compliance.We have concluded that it would be meaningful to incorporate these teaching tools in the curriculum of second year undergraduate students with the goal of making them better physicians in the future.
Quadricuspid aortic valves (QAVs) are a rare congenital anomaly associated with increased risk of aortic insufficiency.This case presents the incidental finding of a quadricuspid aortic valve on intraoperative transesophageal echocardiography after going undetected on transthoracic echocardiography multiple times, suggesting that transesophageal echocardiography may be a superior imaging modality for the identification of this defect.This patient with a history of coronary artery disease presented with sudden onset moderate to severe aortic insufficiency and required subsequent aortic valve replacement (AVR).
Background: In addition to the purposeful teaching of knowledge and skills to medical students, the "hidden curriculum" refers to the inadvertent -and often unrecognized -transmission of implicit ideas, attitudes, and behaviors.One way to raise student and teacher understanding of the hidden curriculum (HC) is to provide them concrete examples of how and when it occurs during medical school.The goal of this study was to investigate how the HC is depicted popular medical television (TV) shows.Methods: A systematic content analysis of successive episodes of eight prime-time TV shows was completed using a standardized classification scheme.A complete season of each TV program was analyzed to identify and classify depictions of the HC as it pertains to medical students.Our classification scheme used four dominant themes: what students discovered about medicine, what students learned about becoming a physician, what students experienced, and what students realized about themselves.After coding, all incidents were classified as "negative" if a rule or normal procedure was broken, or "positive" if they followed established professional values or provided patient-centered care.Results: A total of 137 episodes were viewed with 1160 depictions of the HC portrayed.The TV shows with the most depictions were Code Black and Scrubs.Within the four dominant themes, 45 subthemes were identified.Most depictions (66.7%) were described as positive and included conflict resolution, sensitivity, respect, empathy, accountability and role-modeling.However, 33.3% (386/1160) were negative and included unrealistic patient expectations, working in a chaotic environment, haphazard learning interactions, emotional detachment, loss of idealism, complex social situations, and dealing with uncertainty.Conclusions: Television dramas contain many positive and negative examples of the hidden curriculum during undergraduate medical training.Short snippets from these incidents could be used in an educational setting to teach related issues including professionalism, ethics, role modeling, communication skills, and coping techniques.
Case: We present a case of acute idiopathic four-compartment syndrome of the leg, treated by four-compartment fasciotomy, and wounds left to heal by secondary intention due to persistent edema following surgery. Conclusion:This case highlights the importance of maintaining a high level of clinical suspicion for idiopathic spontaneous compartment syndrome presentation.This case also illustrates the variability of compartment syndrome treatment and recovery.The standard treatment for compartment syndrome is fasciotomy with delayed primary wound closure, but the patient elected to heal by secondary intention.The patient's long term follow-up results showed positive outcomes.
We aim to add to the literature regarding Petit (inferior lumbar) hernias.The presence and location of lower back masses may have a deeper origin than initially apparent.We may urge the surgical community to keep in mind the differential diagnosis of lumbar hernia, although rare, when evaluating subcutaneous masses and lipomata in this region.Simple excision may address the mass but not the cause and will lead to early recurrence of the presenting problem.
Background:Little is known about the ethical issues confronting medical students during their first exposure to emergency medicine (EM).The aim of this study was to review student narratives to determine the type and frequency of ethical issues that beginning students confront in the ED.Methods: This was a prospective, qualitative observational study of consecutive first-and second-year medical students electing to do a pre-clinical clerkship in Emergency Medicine (EM) at five universityaffiliated hospitals.Students were asked to write a short description of three cases that had the greatest impact on them during the month-long clerkship.Each essay was independently analyzed by five members of the research team.Descriptive and kappa statistics were used to summarize the data.Results: During the four-year study period, 292 consecutive student essays were evaluated from 103 medical students.A total of 194 specific incidents were coded across 15 categories of ethical standards.Overall, 71.1% (138/194) were depictions of exemplary instances of ethical issues, 13.9% (27/194) were considered normal interactions, and 14.9% (29/194) were categorized as unethical behavior.While generally impressed by the admirable behavior of faculty and staff, students were quick to describe instances of improper treatment of patients, such as poor communication, discrimination, improper pain management, or a perceived lack of empathy. Conclusions:Narrative essays describe a wide variety of interesting ethical situations that beginning medical students confront during their clerkships.Many of these ethical interactions seem to be connected to the student's role as an observer of the health care team and how that role can lead to ethical tension.As educators, we need to shine a light on the subtle ethical issues that clerkship students struggle with daily and give them practical tools to deal with moral decisions required of them in medical practice.
