Sima S. Desai

Medical student evaluation of the quality of hospitalist and nonhospitalist teaching faculty on inpatient medicine rotations.

Purpose To evaluate the impact of academic hospitalists on third-year medical students during inpatient medicine rotations. Method The authors conducted a retrospective quantitative assessment of medical student evaluations of hospitalist and nonhospitalist Department of Medicine faculty at Oregon Health & Science University, for the 1998–00 academic years. Using a nine-point Likert-type scale, students evaluated the faculty on the following characteristics: communication of rotation goals, establishing a favorable learning climate, use of educational time, teaching style, evaluation and feedback, contributions to the student’s growth and development, and overall effectiveness as a clinical teacher. Results A total of 138 students rotated on the university wards during the study period; 100 with hospitalists, and 38 with nonhospitalists. Of these students, 99 (71.7%) returned evaluations. The hospitalists received higher numeric evaluations for all individual attending characteristics. Significance was achieved comparing communication of goals (p = .011), effectiveness as a clinical teacher (p = .016), and for the combined analysis of all parameters (p < .001). Despite lack of achieving statistical significance, there was a trend toward hospitalists being more likely to contribute to the medical student’s perception of growth and development during the period evaluated (p = .065). Conclusions In addition to performing the responsibilities required of full-time hospital-based physicians, hospitalists were able to provide at least as positive an educational experience as did highly rated nonhospitalist teaching faculty and in some areas performed better. A hospitalist model can be an effective method of delivering inpatient education to medical students.

Uncovering frustrations. A qualitative needs assessment of academic general internists as geriatric care providers and teachers.

BACKGROUND: General internists commonly provide medical care for older adults and geriatric education to trainees, but lack the necessary knowledge and skills to fulfill these tasks.OBJECTIVE: Assess the geriatric training needs of academic general internists in 3 hospital systems in Portland, OR.DESIGN: Ten focus groups and 1 semi-structured interview. Interview transcripts were analyzed using thematic analysis, a well-recognized qualitative technique.PARTICIPANTS: A convenience sample of 22 academic general internists and 8 geriatricians from 3 different teaching hospitals.MEASUREMENTS: We elicited stories of frustration and success in caring for elderly patients and in teaching about their care. We asked geriatricians to recount their experiences as consultants to general internists and to comment on the training of Internists in geriatrics.RESULTS: In addition to deficits in their medical knowledge and skills, our Internists reported frustration with the process of delivering care to older adults. In particular, they felt ill prepared to guide care transitions for patients, use multidisciplinary teams effectively, and were frustrated with health care system issues. Additionally, general internists’ approach to medical care, which largely relies on the medical model, is different from that of geriatricians, which focuses more on social and functional issues.CONCLUSIONS: Although our findings may not be broadly representative, improving our general internists’ abilities to care for the elderly and to teach learners how to do the same should address deficits in medical knowledge and skills, barriers to the processes of delivering care, and philosophical approaches to care. Prioritizing and quantifying these needs and measuring the effectiveness of curricula to address them are areas for future research.

Gender differences in publication productivity, academic rank, and career duration among U.S. academic gastroenterology faculty

Purpose Female representation in academic medicine is increasing without proportional increases in female representation at senior ranks. The purpose of this study is to describe the gender representation in academic gastroenterology (GI) and compare publication productivity, academic rank, and career duration between male and female gastroenterologists. Method In 2014, the authors collected data including number of publications, career duration, h-index, and m-index for faculty members at 114 U.S. academic GI programs. Results Of 2,440 academic faculty, 1,859 (76%) were men and 581 (24%) were women. Half (50%) of men held senior faculty position compared with 29% of women (P < .001). Compared with female faculty, male faculty had significantly (P < .001) longer careers (20 vs. 11 years), more publications (median 24 [0–949] vs. 9 [0–438]), and higher h-indices (8 vs. 4). Higher h-index correlated with higher academic rank (P < .001). The authors detected no difference in the h-index between men and women at the same rank for professor, associate professor, and instructor, nor any difference in the m-index between men and women (0.5 vs. 0.46, respectively, P = .214). Conclusions A gender gap exists in the number and proportion of women in academic GI; however, after correcting for career duration, productivity measures that consider quantity and impact are similar for male and female faculty. Women holding senior faculty positions are equally productive as their male counterparts. Early and continued career mentorship will likely lead to continued increases in the rise of women in academic rank.

Stress-induced peptide release from rat intermediate pituitary : an ultrastructural analysis

SummaryWe tested the hypothesis that acute restraint stress results in ultrastructural evidence for enhanced release of alpha-melanocyte-stimulating hormone (α-MSH) and β-endorphin from the intermediate lobe (IL) of the rat pituitary. Measurements of plasma α-MSH-and β-endorphin-immunoreactivity (ir) were used to confirm ultrastructural findings. Plasma α-MSH-ir was elevated after 20 and 30 min of restraint while plasma β-endorphin-ir peaked 10 min after the onset of restraint. Ultrastructural analysis revealed a decrease in the content of secretory granules within IL cells of stressed rats. Analysis of Golgi-related immature secretory granules in IL cells indicated that new peptide synthesis was not enhanced after 30 min of restraint. These results confirm previous studies showing and elevation of plasma β-endorphin and α-MSH-ir during acute restraint. Furthermore, these results indicate that quantitative analysis at the ultrastructural level can be used to assess peptide release from IL secretory cells during stress.

Aiming to improve care of older adults: an innovative faculty development workshop.

Introduction/ AimsInternists care for older adults and teach geriatrics to trainees, but they often feel ill-prepared for these tasks. The aims of our 1-day Continuing Medical Education workshop were to improve the knowledge and self-perceived competence of general internists in their care of older adults and to increase their geriatrics teaching for learners.SettingTwo internal medicine training programs encompassing University, Veterans Affairs, and a community-based hospital in Portland, OR, USA.Program DescriptionCourse faculty identified gaps in assessment of cognition, function, and decisional capacity; managing care transitions; and treatment of behavioral symptoms. To address these gaps, our workshop provided geriatric content discussions followed by small group role plays to apply newly learned content. Forty teaching faculty participated.Program EvaluationParticipants completed 13-item multiple-choice pre- and post-workshop geriatric knowledge tests, pre- and post-workshop surveys of self-perceived competence to care for older adults, and completed an open-ended ‘commitment to change’ prompt after the intervention. Knowledge scores improved following the intervention (61% to 72%, p < .0001), as did self-perceived competence (11 of 14 items significant). Seventy-one percent of participants reported success in meeting their commitment to change goals.DiscussionA 1-day intervention improved teaching faculty knowledge and self-perceived competence to care for older patients and led to self-perceived changes in teaching behaviors.

Transitioning Toward Competency: A Resident-Faculty Collaborative Approach to Developing a Transitions of Care EPA in an Internal Medicine Residency Program

BACKGROUND Residency training and evaluation are moving toward competency-based models. Managing transitions of care is 1 of 16 entrustable professional activities (EPAs) that signal readiness for independent internal medicine practice. Methods for developing EPAs are evolving within the medical education community. OBJECTIVE We describe a process for developing a transitions-of-care EPA for internal medicine inpatient and ambulatory settings using an iterative, consensus-building, resident-faculty collaborative approach. METHODS We used an independent rank-ordering process and successive consensus group meetings to cull an initial list of 142 developmental Milestones to the 15 most relevant to transitions of care for internal medicine patients in an academic medical center and affiliated Veterans Administration hospital. Four senior internal medicine residents and 4 internal medicine faculty members representing inpatient and ambulatory practice settings identified examples of specific tasks and evaluative techniques for each Milestone. RESULTS We demonstrate a feasible resident-faculty collaboration to develop transitions of care as an EPA for an internal medicine training program. Inclusion of residents along with faculty provided broader insights as well as an important learning opportunity for trainees. CONCLUSIONS Our process demonstrated the feasibility of designing an EPA, but questions remain about how entrustment-based evaluation can be implemented in clinical settings. Our framework may serve as a foundation for EPA development in other areas of clinical practice.

Restoration of resident sleep and wellness with block scheduling

Block scheduling during residency is an innovative model in which in‐patient and ambulatory rotations are separated. We hypothesised that this format may have a positive impact on resident sleep and wellness in comparison with a traditional format.

Catastrophic antiphospholipid syndrome in a patient with systemic sclerosis and hereditary angioedema: case report and literature review

Abstract Catastrophic antiphospholipid syndrome (CAPS) is a rare form of the antiphospholipid syndrome (APS) in which microvascular thrombotic events cause rapidly progressive multiorgan dysfunction. We describe a case of CAPS presenting in a patient with suspected systemic sclerosis (SSc) and hereditary angioedema (HAE), and conduct a literature review to examine the reported cases of CAPS in individuals with SSc. Two reported cases of APS occurring with HAE were also found. In CAPS, there may be multiple thrombi in the microvasculature of any organ, most commonly in the intra-abdominal viscera. Patients rapidly develop multiorgan dysfunction or failure. Diagnosis is partly based upon the presence of positive antiphospholipid antibodies. The recommended therapy is systemic anticoagulation, high-dose corticosteroids, and plasma exchange with or without the addition of intravenous immunoglobulin. Given the high mortality rate of CAPS, urgent diagnosis and treatment are necessary to attempt to halt the progression of multiorgan failure.

A Couple’s Colitis

A 32-year-old woman was admitted with 4 days of bloody diarrhea, abdominal pain, leukocytosis, and fever following fast food consumption and use of methamphetamine. An abdominal CT scan revealed continuous colonic mural thickening from the cecum to the splenic flexure (Fig. 1). Stool cultures for bacteria, ova and parasites, and fecal leukocytes were negative. Her symptoms resolved with supportive care, and on the day of discharge, her partner presented with identical symptoms (Fig. 2). His stool cultures grew shiga toxin 2-producing E. coli, serogroup O157:H7 (STEC). Based on his positive stool culture and the presence of diffuse colitis on both scans, a final diagnosis of STEC was given to both patients.