Arnyce Pock

Battlefield acupuncture: Opening the door for acupuncture in Department of Defense/Veteran's Administration health care

Battlefield acupuncture is a unique auricular acupuncture procedure which is being used in a number of military medical facilities throughout the Department of Defense (DoD). It has been used with anecdotal published positive impact with warriors experiencing polytrauma, post-traumatic stress disorder, and traumatic brain injury. It has also been effectively used to treat warriors with muscle and back pain from carrying heavy combat equipment in austere environments. This article highlights the history within the DoD related to the need for nonpharmacologic/opioid pain management across the continuum of care from combat situations, during evacuation, and throughout recovery and rehabilitation. The article describes the history of auricular acupuncture and details implementation procedures. Training is necessary and partially funded through DoD and Veterans Administration (VA) internal Joint Incentive Funds grants between the DoD and the VA for multidisciplinary teams as part of a larger initiative related to the recommendations from the DoD Army Surgeon Generals Pain Management Task Force. Finally, Uniformed Services University of the Health Sciences School of Medicine and Graduate School of Nursing faculty members present how this interdisciplinary training is currently being integrated into both schools for physicians and advanced practice nurses at the Uniformed Services University of the Health Sciences. Current and future research challenges and progress related to the use of acupuncture are also presented.

Report from the 9th International Symposium on Auriculotherapy Held in Singapore, 10–12 August 2017

Auricular interventions also known as auriculotherapy, auricular medicine and ear acupuncture depending on practice locale, has come of age and has gained the attention of the wider medical community in recent years.[...]

Attitudes toward professionalism maintained after curriculum reform

Dear Editor The 2010 Carnegie Report[1] recommended incorporating a greater amount of clinical material into the first 2 years of medical school, with the goal of enhancing the ability of students to acquire, appreciate, and use patient-first behaviors, communication skills, and professional attitudes and behaviors. How to teach and evaluate professionalism in medical students is an area of much research.[2–4] Our study addressed the impact of our new curriculum on how medical students analyse professional or unprofessional behavior through their reflective practice essays. It used qualitative analysis to understand a pediatric clerk’s viewpoint of professionalism, both preand post-curriculum reform. At the Uniformed Services University of the Health Sciences (USUHS), the School of Medicine converted a traditional, discipline-based curriculum into one that combines an integrated, organ-system based focus with a deliberate interweaving of clinical medicine throughout the entire pre-clerkship period. Core clerkships now begin at the 18 month point – vs. after 2 years of study dedicated to the basic sciences in the old curriculum. The new curriculum also includes an earlier introduction to clinical medicine, incorporating home visits and patient interviewing skills into the first few weeks of medical school. USUHS pediatric clerks are required to write a reflective practice essay, discussing an instance of professional or unprofessional behavior that the student witnessed, and the effect that episode had on the student. With Institutional Review Board approval, we used qualitative techniques (grounded theory and constant comparison)[5, 6] to analyse the themes in the essays from the year before curriculum change (n = 119), and compared them to the themes that emerged in essays prepared by students who matriculated into the new curriculum (n = 151). Several 4th-year medical students participated in coding each year’s data. We noted the medical student coders frequently had insights into new codes or themes the senior researchers missed. Codes were independently developed using line-by-line coding and then discussed between the two investigators until consensus was achieved. Seventy initial codes were found that were organised into six themes. Coders were alert to possible new themes in the post curriculum reform essays. Interestingly, both sets of essays described the same 6 robust themes relating to professionalism: Physicians’ unique and complex role ‘I learned that a doctor must not only handle the technical aspects of treating patients but also understand and alleviate pain at an emotional level. This humbling experience is one of the most important that I reflect on when I try to understand the roles we play in patient’s lives.’ Analysed learning environment ‘Over my hospital rotations one thing has bothered me more than anything, the prevalent undercurrent of disrespectful interpersonal interactions between staff members, the hubris of medicine’s nasty side.’ Behind the scenes ‘Working with such a diverse team and seeing the value of what each service had to offer is definitely something I’ll take away...’ Reflection about the clinical environment ‘it struck me how hard it is sometimes to remain non-biased in such a hostile family environment.’ Reflections about self ‘I have been doing too much ‘covering my butt’ instead of really taking care of my patients. I was more motivated by trying to please my preceptors and getting good grades than I was motivated to take care of the needs of my patients ... .’ Implications for the future ‘... health care is never “business as usual,” ... each patient is different.’ We noted a pattern in the essays in both years. Students reported an observation, proceeded to analyse the learning experience, then moved to contemplate the implications for the future; in which they determined ways to avoid making mistakes, thought about how to improve patient care, and reflected on patient outcomes. Some students took the analysis one step further to develop a plan for their own behaviour change or to propose a moral principle of professionalism they believed was linked to their learning experience. How was it the same qualitative analysis themes were found in the reflective practice essays, pre and post curricular revision, despite the shorter pre-clerkship experience in the new curriculum? We posit this may be related to the

Why not wait? Eight institutions share their experiences moving United States medical licensing examination step 1 after core clinical clerkships

The majority of medical students complete the United States Medical Licensing Examination Step 1 after their foundational sciences; however, there are compelling reasons to examine this practice. This article provides the perspectives of eight MD-granting medical schools that have moved Step 1 after the core clerkships, describing their rationale, logistics of the change, outcomes, and lessons learned. The primary reasons these institutions cite for moving Step 1 after clerkships are to foster more enduring and integrated basic science learning connected to clinical care and to better prepare students for the increasingly clinical focus of Step 1. Each school provides key features of the preclerkship and clinical curricula and details concerning taking Steps 1 and 2, to allow other schools contemplating change to understand the landscape. Most schools report an increase in aggregate Step 1 scores after the change. Despite early positive outcomes, there may be unintended consequences to later scheduling of Step 1, including relatively late student reevaluations of their career choice if Step 1 scores are not competitive in the specialty area of their choice. The score increases should be interpreted with caution: These schools may not be representative with regard to mean Step 1 scores and failure rates. Other aspects of curricular transformation and rising national Step 1 scores confound the data. Although the optimal timing of Step 1 has yet to be determined, this article summarizes the perspectives of eight schools that changed Step 1 timing, filling a gap in the literature on this important topic.

AM Last Page. The "Pillars" of Curriculum Reform.

References 1. Cooke M, Irby DM, O’Brien B. Educating Physicians: A Call for Reform of Medical School and Residency. Stanford, Calif: JosseyBass; 2010. 2. Pangaro L, ten Cate O. Frameworks for learner assessment in medicine: AMEE Guide No. 78. Med Teach. 2013;35:e1197–1210. 3. Novak J, Canas AJ. The theory underlying concept maps and how to construct and use them. http://cmap.ihmc.us/publications/researchpapers/theorycmaps/theoryunderlyingconceptmaps.htm. Accessed September 16, 2014. 4. Lave J, Wenger E. Situated Learning: Legitimate Peripheral Participation. Cambridge, UK: Cambridge University Press; 1991. 5. Kerfoot BP, DeWolf WC, Masser BA, Church PA, Federman DD. Spaced education improves retention of clinical knowledge by medical students: A randomized controlled trial. Med Educ. 2007;41:23–31. Disclaimer: The views expressed are those of the authors and do not reflect the official policy or position of the Uniformed Services University of the Health Sciences, the Department of Defense, the United States Air Force, or the United States Government. Author contact: Arnyce.pock@usuhs.edu Medical schools have been engaged in curricular reform for over 20 years, although the 2010 release of the Carnegie Foundation’s Educating Physicians: A Call for Reform of Medical School and Residency galvanized the effort across the United States and Canada. The report’s authors suggested four key elements, which we describe below along with some examples of how they can be implemented.

Undergraduate medical education: past, present, and future.

Editor’s Note: Many schools of medicine in the United States are currently revising or just recently completed major revisions of their medical school curricula. This commentary incorporates the perspectives of a recent future-oriented Surgeon General, the Dean of the Uniformed Services University of the Health Sciences’ School of Medicine, a nationally renowned educational scholar, and a senior physician who were charged with coordinating the design and implementation of the first major revision of the University’s medical school curriculum in over 30 years. We hope you’ll find their shared perspectives of interest.

Pathology Course Director Perspectives of a Recent LCME Experience: Preparation in an Integrated Curriculum With the Revised Standards

Preparation for a Liaison Committee of Medical Education (LCME) accreditation site visit is a daunting task for any medical school, particularly for medical schools that have adopted integrated curricula. The LCME accreditation is the standard that all US and Canadian allopathic medical schools must meet in order for the school to award the degree of medical doctor. The Uniformed Services University of the Health Sciences (USU) recently underwent a full-scale LCME accreditation visit that was conducted under the newly revised LCME standards and elements. The site visit occurred just 5 years after our school began implementing a totally revised, organ system-based curriculum. Preparing for a critical, high-stakes site visit shortly after transitioning to a totally revised, integrated module-based preclerkship curriculum presented an array of new challenges that required a major modification to the type of preparation, communication, and collaboration that traditionally occurs between course directors and departmental chairs. These included the need to ensure accurate, timely communication of curricular details to different levels of the academic administration, particularly as it related to the execution of self-directed learning (SDL). Preparation for our site visit, did, however, provide a novel opportunity to highlight the unique educational experiences associated with the study of pathology, as pathology traverses both clinical and basic sciences. Sharing these experiences may be useful to other programs that are either undergoing or who are preparing to undergo an accreditation visit and may also aid in a broader communication of the highlights or initiatives of educational activities.