IntroductionCapstone projects are active and integrative, compared to passive learning from didactic lectures. Although some healthcare programs utilize these modalities, capstone projects have not been reported in a premedical master’s program. We introduced a joint physiology-pharmacology capstone project in a premedical master’s program.MethodsThe joint capstone project was introduced in Spring 2022 across dual campuses with a total of 72 students. Students were divided into teams, and each team selected a disease-drug pair from a list of faculty-provided options. Students investigated the disease-related physiologic changes in multiple organ systems, general treatment strategy, novel drug development, and the new drug’s mechanism of action and side effects. Finally, each team generated a slide set and delivered a presentation. Each student was required to submit a reflection about the capstone project. The Block 4 Physiology exam assessed learning objectives derived from the core concepts presented in the students’ capstone projects. At the end of the semester, an anonymous survey collected students’ evaluations and feedback.ResultsStudent performance on the joint capstone project was excellent, with an average of above 93.5% on all physiology, pharmacology, and common domains. The mean performance on questions related to capstone diseases (self-learning) was similar to the average performance on the teacher-taught content in the Block 4 exam of the Physiology course. There were 72 (100%) responses to the evaluation survey. The majority of students (77.8% - 88.9%) agreed and strongly agreed that the joint capstone project facilitated self-directed learning of the pathophysiology, clinical trials, drug development, and therapeutic management of diseases. Students felt strongly that the joint capstone project enhanced the integration of physiology, pharmacology, and diseases. Teamwork was highly appreciated by students as well. In students’ reflections, integration, teamwork, and future application were the most common themes.ConclusionA joint Physiology-Pharmacology capstone project in a premedical master’s program could be an effective and efficient strategy to enhance premedical students’ ability to integrate physiology, pharmacology, and disease. This project cultivates self-directed learning and teamwork.

New patients turning to semaglutide (Ozempic® and Wegovy®), a glucagon-like-peptide 1 (GLP-1) agonist, for weight loss, have captivated social media platforms.  Wegovy® carries a United States (US) Food and Drug Administration (FDA) approval for chronic weight management in patients who have a body mass index (BMI) 27 kg/m2 or greater and at least one weight-related condition (eg, hypertension, type 2 diabetes, cholesterol) or in patients with a 30 kg/m2 or greater BMI. Although other semaglutide formulations are not FDA approved for weight loss, the term "Ozempic face" has consumed the media with the medication's rising popularity. This term is a new purported side effect, used to describe the rapid facial weight loss leaving a distorted facial appearance. This challenges the healthcare team to discern whether a new adverse effect is a novel or a natural consequence of rapid weight loss. Dermatologists are well positioned to counsel patients receiving or discontinuing GLP-1 agonists and recommend appropriate countermeasures, as appropriate.  J Drugs Dermatol. 2024;23(1):1367-1368.      doi:10.36849/JDD.7613.

Background: The institutional culture where students complete training may significantly impact their professional identity and practice habits related to osteopathic medicine principles and the use of Osteopathic Manipulative Treatment (OMT). This is the first study to evaluate institutional culture, perspectives, knowledge, behaviors, and the effect of an educational intervention among an institution's employees surrounding the principles of osteopathic medicine. Objective: To explore the impact of a standardized educational intervention in osteopathic medicine for employees in promoting greater integration of osteopathic principles and practice into our institutional culture at a single multi-campus institution.. Methods: A cross-sectional study was conducted to assess osteopathic knowledge, perspectives, and behaviors through two surveys provided before and 6 months after an educational intervention. The educational intervention consisted of 7 online, asynchronous modules. A baseline (PRE) survey and 6-month follow-up (POST) were treated as independent samples, as not all study respondents participated in the educational intervention. Contingency tables were generated for the preliminary data set to assess the relationships among survey responses. Chi-square tests were conducted to test relationships and Fisher Exact Tests employed when assumptions for the chi-square test were not met. Analyses of variance and independent t-tests were conducted to evaluate score differences across different employment categories and backgrounds. Results: All employees were invited to participate in the study, 96/370 (25.9 %) completed the PRE and 94/370 (25.4 %) completed the POST surveys. In the POST survey, 45/94 (47.9 %) of respondents indicated they participated in the educational modules. After the training, a greater number of participants agreed or strongly agreed that they understand the fundamentals of OPP [PRE: 80/95 (84.2 %); POST: 88/92 (95.7 %); P = 0.01] and the origins and history of osteopathic medicine in the United States [PRE: 62/94 (66 %); POST: 79/92 (85.9 %); P = 0.003]. Within the administrators/staff category, significantly more had experienced OMT at the end of the study [PRE: 38/48 (79.2 %); POST: 45/48 (93.8 %); P = 0.04]. There were significantly more participants who correctly identified body systems impacted by OMT [PRE: 68/96 (70.8 %); POST: 79/93 (84.9 %); P = 0.01]. Faculty planned to integrate osteopathic principles into their teaching [37/40 (92.5 %)] and written exam items [25/40 (62.5 %)] in the future. Finally, employee participants in the training [50/51 (98 %)] reported an impact on their confidence in discussing Osteopathic Principles and Practice (OPP) with others, and believed the training increased their awareness of OPP in their work [46/51 (90 %)]. Conclusions: An educational intervention positively impacted employees' perspectives, knowledge, and behaviors related to OPP at a multi-campus, osteopathic institution. Enhanced engagement with institutional osteopathic culture fosters an informed workforce, and may influence student engagement with OPP in their future practice. Implications for educational practice: center dot An educational intervention in osteopathic principles positively impacts the perspectives, knowledge, and behaviors of employees of an osteopathic institution in relation to Osteopathic Principles and Practice. center dot Providing focused training in osteopathic principles to employees may result in fewer misunderstandings within osteopathic organizations. center dot Employees trained in osteopathic principles may provide more consistent public messaging, enhancing public awareness about the osteopathic medical profession. center dot Institutions who seek to increase employee knowledge about osteopathic principles may influence student engagement with osteopathic principles and osteopathic manipulative treatment, furthering the distinctiveness of osteopathic medical practice.

Nirmatrelvir-ritonivir (Paxlovid) recently received emergency use authorization for the treatment of coronavirus disease 2019 (COVID-19). Literature has linked numerous cutaneous adverse effects to nirmatrelvir and ritonavir, the copackaged tablets within Paxlovid. A review and comparison of these adverse effects to the common cutaneous manifestations of COVID-19 is provided. Numerous drug-to-drug interactions exist between nirmatrelvir-ritonivir and commonly-used medications within dermatology.

Actemra (tocilizumab) received emergency use authorization for the treatment of coronavirus disease 2019 (COVID-19) in June 2021. Literature has linked numerous cutaneous adverse effects to tocilizumab. In this current survey, investigators reviewed and compared these adverse effects to the common cutaneous manifestations of COVID-19. While similarities in patient presentation exist, important distinctions are made to aid dermatologists in their clinical diagnosis.  J Drugs Dermatol. 2023;22(12):e42-e43.     doi:10.36849/JDD.6532e.

Context: The United States Medical Licensing Examination (USMLE) Step 1 and Comprehensive Osteopathic Medical Licensing Exam (COMLEX) Level 1 transitioned from a numeric scoring system to a Pass/Fail designation in 2022. This transition intended to decrease stress, improve medical student well-being, and encourage residency program directors to emphasize other aspects of residency applications. Pass/Fail score transitions in the undergraduate medical education curriculum have improved medical student psychological well-being and satisfaction; whether these same benefits translate to the board examination period is unknown. Objectives: The objectives of this study are to assess the impact of USMLE Step 1 and COMLEX Level 1 grade scale transition on medical student stress, wellness, board preparation decisions, and future residency selection processes. Investigators hypothesized that students under the Pass/Fail designation would experience less stress during the intensive study period leading up to USMLE Step 1 and COMLEX Level 1 and devote more time to other aspects of their residency applications. Methods: To examine the impact on osteopathic medical student (OMS) stress and approach to board preparation, two surveys were administered to Rocky Vista University College of Osteopathic Medicine (RVU-COM) students before (Class of 2023) and after (Class of 2024) the transition to a Pass/Fail designation. All students within the RVU-COM Classes of 2023 and 2024 were invited to participate. The Cohen Perceived Stress Scale (PSS-10) was administered at the beginning of the focused board study period in May 2021 and 2022 to the Class of 2023 and 2024, respectively. The investigator-designed Licensing Exam Questionnaire (LEQ), meant to capture board preparation patterns, residency application perspectives, and wellness during examination preparation, was administered immediately after the board examination deadline in July 2021 and 2022 to the Class of 2023 and 2024, respectively. Statistical analysis included the use of independent t tests (numeric variables) and chi-square tests (categorical data). This project was considered exempt from full Institutional Review Board review. Results: Approximately one-third of the Class of 2023 (PSS-10: n=86; LEQ: n=93) and 2024 (PSS-10=89; LEQ: n=92) responded. No difference was detected in mean PSS-10 score, 20.14 (SD=7.3) compared to 19.92 (SD=6.56) for the Class of 2023 and 2024 (p=0.84), respectively. The Class of 2023 reported more weeks studying (mean 6.27 weeks, SD=0.79) vs. the Class of 2024 (mean 5.44 weeks, SD=0.007), p<0.001, more practice examinations taken X-2 (1, n=182)=13.75, p<0.001, and a greater proportion scheduled examinations after June 20 X-2 (1, n=182)=29.01, p<0.001. No difference existed in hours studying per day, sequence of Step 1/Level 1, time between examinations, money spent, or type of study resources utilized. Conclusions: The transition of USMLE Step 1 and COMLEX Level 1 to a Pass/Fail designation did not reduce stress for OMSs at a single, multicampus COM. Respondents, however, altered board preparation practices in meaningful ways. As student behaviors and board-study patterns emerge, these insights must be connected to outcomes in the future.

This chapter examines emerging side effects of vitamins, amino acids, nutrition formulations, and complementary and alternative medicine. Literature cited includes publications from January to December 2022. Last year, vitamin A derivatives caused musculoskeletal, mucocutaneous, bone, and electrolyte abnormalities. All-trans retinoic acid resulted in bone marrow necrosis and idiopathic intracranial hypertension, while isotretinoin produced back pain, sacroiliitis, skeletal hyperostosis, rhabdomyolysis, hair loss, and hypercalcemia. Available evidence suggests healthcare professionals must carefully identify drug-induced toxicity as misdiagnosed anaphylaxis occurred in a patient experiencing a niacin overdose. Thiamine dose optimization may be an appropriate primary prevention strategy for hypertension. Emerging evidence suggests vitamin C use in critical illness may increase risk of death or persistent organ dysfunction. A new drug–disease interaction was uncovered in a patient with sarcoidosis receiving vitamin D supplementation that resulted in hypercalcemia. Focused investigation into real-world vaping practices and pathophysiologic mechanisms is required to strengthen the link between vitamin E acetate in vaping products and E-cigarette or Vaping product use-Associated Lung Injury. Retrosternal discomfort and pill-induced esophagitis occurred in a pediatric patient receiving l-arginine. Energy-dense enteral nutrition increased patient risk of large gastric residual volumes and gastrointestinal complications. Patients receiving early parenteral nutrition, who are older, and have higher mortality risk scores should be monitored for refeeding hypophosphatemia. Finally, the first case of lipid emulsion-induced hypertension was identified. This chapter aims to increase healthcare practitioner knowledge to encourage appropriate identification, management, and prevention of toxicity.

With the emergence of a novel severe acute respiratory syndrome coronavirus, investigators worldwide are scrambling to identify appropriate treatment modalities, develop accurate testing, and produce a vaccine. To date, effective treatment remains elusive. Chloroquine phosphate and hydroxychloroquine sulfate (HCQ), well-known antimalarial drugs effective in the treatment of systemic lupus erythematosus, rheumatoid arthritis, porphyria cutanea tarda, and chronic Q fever, are currently under investigation. The United States Food and Drug Administration recently issued an Emergency Use Authorization for CQ and HCQ use in the treatment of coronavirus disease 2019 (COVID-19). With spikes in HCQ use and demand, ethical considerations encompassing appropriate use, patient autonomy, nonmaleficence, and distributive justice abound. As drug experts, pharmacists are uniquely positioned to advocate for patients with chronic conditions necessitating HCQ use, assist in the appropriate prescribing of HCQ for COVID-19, and ensure patients and health care professionals are continually educated during this public health crisis. This review highlights the worldwide pandemic, describes appropriate HCQ use for chronic conditions, highlights available alternatives, and deliberates evolving ethical questions. With assistance from colleagues, state boards of pharmacy, and national organizations, pharmacists ensure the just distribution of valuable pharmaceuticals to patients having COVID-19 while supporting the needs of patients requiring HCQ for chronic conditions.

Context: The overlap between medical school, residency, and childbearing potential increases the likelihood a woman will pursue parenthood within her, or her partner's, medical training. Parental leave benefits mothers, fathers, and infants. Adequate parental leave promotes physical recovery, mental health, infant bonding, improved breastfeeding, appropriate childhood immunization, and familial engagement. Despite the risks and benefits, the United States does not have national paid maternity, paternity, or parental leave requirements. Complicating matters for medical trainees, parental leave policies are not well-defined within the undergraduate (UME) and graduate medical education (GME) realms. Significant policy advancements are on the horizon for GME; however, medical schools are left without evidence to support policy formation. Objectives: This study aims to identify the presence and nature of maternal/paternal leave policies and procedures within UME. Given the authors' close association with osteopathic medical education, only osteopathic medical schools were considered to lay the framework for future study in UME. Methods: Investigators searched university websites for student handbooks outlining rules and policies surrounding parental leave. The following terms were utilized to investigate these documents: "parental," "maternity," "paternity," "pregnant," "pregnancy," and "leave of absence" (LOA). Administrative personnel were contacted, and subjective data were documented. A parental leave policy was defined as explicitly dedicated to expectant parents or those parents planning on adoption. Medical leave or other short- and long-term LOA policies were not considered a parental leave policy. Results: A total of 42 osteopathic medical schools were identified. Investigators established email communication with 17 schools (40.5%). Neither a student handbook nor email contact could be made with one institution. Two (4.9%) osteopathic medical schools overtly described parental leave in their policies. The majority of schools recommended students seeking parental leave follow short- or long-term LOA policies. Conclusions: Without protected leave time, students must decide whether to begin a family or delay medical education. As GME begins prioritizing policy change, the authors call on UME to follow suit. Parenthood and medicine must be intertwined.

Androgenic alopecia (AGA) is the most common form of non-scarring alopecia, affecting millions of men and women in the United States (U.S.). This review highlights alternative and complementary treatment options for AGA. The treatment regimens for AGA have increased in pharmacotherapeutics, surgical, and complementary (CAM) categories. Each of the different treatment approaches can now be utilized by dermatologists to combat patient hair loss. The U.S. Food and Drug Administration (FDA) has approved only two agents to treat AGA: prescription-only, oral finasteride and over-the-counter (OTC), topical minoxidil. Increased availability of therapies claiming hair regrowth properties, coupled with limited pharmacotherapeutic options for AGA, lead patients to seek alternative treatments. Increased awareness of the current evidence supporting complementary and alternative therapies among dermatologists will facilitate appropriate and timely education of AGA patients.

Vitamins and their prescription derivatives, amino acids, and nutritional formulations have wide and varied clinical applications. Many are available over the counter, and are often not considered of consequence to patients, making use difficult to monitor. Although well-tolerated in the majority of persons, unique side effects continue to emerge. These products carry potentially harmful side effects in unsuspecting consumers, requiring healthcare providers remain vigilant in questioning, documenting, and counseling patients. This chapter delves into recent literature surrounding vitamin A and its derivatives (isotretinoin, all-trans retinoic acid), vitamin B (pyridoxine, folic acid), vitamins C, D, E, and K, as well as amino acids (arginine, glutamine), enteral and parenteral nutrition. A special review of e-cigarette, or vaping, product use-associated lung injury (EVALI) is included. In most cases, rapid discontinuation of the substance is required; in others, it is the excess or lack of a critical component that leads to toxicity. This chapter reviews literature published between January and December 2020 and will arm healthcare providers with critical knowledge of new and emerging side effects. Ultimately, increased awareness among providers will aid in the rapid identification and management of patients, improving care and outcomes.

During the 2018–2019 academic year, OMS‐II students at Rocky Vista University were introduced to pre‐recorded video lectures (PRVL) as a modality of learning and preparing for pharmacology clinical integration sessions. Traditionally, our university uses designated student assignments (DSA), traditional lectures, and clinical integration sessions (CIS) as methods of delivering pharmacology material. The purpose of adding PRVL was to introduce or “prime” students for future lectures and clinical integration sessions. In contrast to a flipped classroom, the PRVL simply highlight important concepts for lecture or introduce difficult subjects. They are meant to augment the other learning modalities, not to replace traditional lecture, which is typically seen in a true flipped classroom. We focused our research on assessing the efficacy of PRVL as measured by performance on exam questions. We hypothesized that access to PRVL would improve performance on pharmacology topics compared to previous classes at Rocky Vista University who did not have this additional resource. To determine whether students utilized the pre‐recorded video lectures, we administered a survey to all OMS II students, focusing on identifying which resources students used most often to learn pharmacology. Survey responses and student performance data were linked using participant numbers that were deidentified. Out of 271 total students, 97 students (a 35.8% response rate) responded to this voluntary survey. We found that 85% of survey respondents utilized the pre‐recorded video lectures >60% of the time. Comparing student performance on 30 pharmacology test items that assessed topics presented in PRVL, students who reported using PRVL <60% of the time scored slightly higher than students who used PRVL the majority of the time. In addition, 97% of students found PRVL to be a useful resource, but when asked whether it was the most useful resource of all modalities available, it was the least favored by students with only 8.2% of respondents preferring PRVL. These results are limited by small sample size, particularly in the group of students who used PRVL < 60% of the time (N=14). We hope to expand these findings by comparing cumulative performance on pharmacology test items before and after PRVL implementation.