Browsing by Subject "Quality Improvement, Global Health, Medical Education, Community Health, and Research Design"
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Item How Learning Strategies and Academic Parameters Predict Medical Student Success(2024-01-30) O'Connell, Michael; Badia, Rohit; Tellez, Juan; Cook, Grayden; Sachs, ArleneBACKGROUND: Student scores on the Learning and Study Strategies Inventory (LASSI), an assessment of academic skills, have been shown in previous studies to be significantly different between U.S. medical students based on their scores in various examinations during the preclerkship curriculum. This study aimed to evaluate LASSI and other early academic performance markers for predicting the likelihood of shelf exam underperformance in third-year medical students. METHODS: A retrospective analysis of student-specific demographic information and medical school exam performance from 220 medical students from the University of Texas Southwestern was performed. Students were then categorized based on underperformance (score in <25th percentile) on each NBME shelf exam and statistical analysis was performed to identify predictors of shelf underperformance. RESULTS: For predicting Surgery shelf underperformance, pre-clerkship final exam average (PCA), STEP 1, and LASSI Time Management (TMT) were statistically significant in univariate analysis. Internal Medicine: PCA, STEP 1, LASSI Attitude (ATT), Test Strategies (TST), and TMT. Pediatrics: PCA and STEP 1 quartile. Obstetrics-Gynecology: PCA, STEP 1, and LASSI Anxiety (ANX), with ANX an independent predictor on multivariate analysis. Neurology: PCA, STEP 1, LASSI ANX, Information Processing (INP), TST, and average LASSI, with PCA, LASSI Concentration (CON), TMT, and ANX independent predictors on multivariate analysis. Family Medicine: PCA, STEP 1, LASSI ANX, TST, and Using Academic Resources (UAR), with PCA an independent predictor on multivariate analysis. Psychiatry: only STEP 1 was significant. CONCLUSION: In contrast to previous studies, no single LASSI scale was significantly associated with underperformance on all 7 NBME shelf exams. Univariate analysis identified several LASSI scales that correlated with NBME underperformance, but the drastic inter-clerkship heterogeneity makes use of these scales in early academic intervention impractical. Conversely, PCA was found to be strongly associated with shelf exam underperformance.Item Incorporating Real-Time Audiovisual and Haptic Feedback in a Novel Thoracostomy Tube Training Model(2024-01-30) Najjar, Alex; Hegde, Shruti; Hofman, Emily; Dubagunta, Sruthi; Awad, Daniel; Khan, Omar; Eisaman, Kraigen; Hossain, Ifti; Walker, James; Sherman, Bradley; Kadakia, Yash; Park, CarolineINTRODUCTION: Simulation-based training can enhance clinical performance, but chest tube insertion is challenging to simulate due to the precision needed for controlled pleural entry. This study evaluates the efficacy of a novel training model with real-time pressure monitoring and audiovisual feedback for force and time to pleural entry in a model. METHODS: The model consisted of a Kelly clamp with force sensors installed at the index finger (sensor 1) and both finger loops (sensors 2 and 3) and a manikin with a replaceable chest wall pad. Data obtained from experts indicated standard force value for pleural entry (Newtons, "N") and acceptable time to completion (3000-5000 milliseconds, "ms"). Thirteen participants ranging from PGY-1 to PGY-6 were introduced to the procedure and model. Force and time were measured from dermal entry to pleural space puncture. A significant drop in pressure suggested puncturing through the chest wall. RESULTS: Force was measured in the linear, plateau, and drop phases of the procedure. Linear phase (~3,000ms) was from start to point of maximum force (<30N). Plateau phase was from maximum force until drop phase. Drop phase was a drop in pressure by >5 Newtons within 150ms indicating procedure completion (pleural entry). All participants successfully completed the task. Pleural entry force ranged from 17N to 30N, and time to pleural entry ranged from 7,500-15,000ms. Of note, left-handed participants relied more on sensors 1 and 3 while right-handed participants relied more on sensors 1 and 2. Thus, only force measurements from sensor 1 were utilized to standardize our assessment. CONCLUSIONS: This novel chest tube trainer with continuous force monitoring can be applied to training for a variety of scenarios, including vascular access, trocar placement and other common procedures. Next steps involve evaluating its impact on trainee accuracy and efficiency.Item Parental Leave Experience for Academic Neurology Faculty at 19 Academic Centers(2023-01-31) He, Annie; Grewal, Parneet; Rodrigues, Kamala; Shah, Suma; Alexander, Halley; Yang, Ailing; Ayub, Neishay; Allendorfer, Jane; Nobleza, Christa O'Hana; Kung, Doris; Frost, Natasha; Nagpal, Seema; Durica, Sarah; Silver, Julie; Patel, Sima; Alick Lindstrom, SashaDespite the rising number of women in academic neurology, there continues to be variability in parental leave (PL) policy, and we need to better understand the impact of PL on career achievements and burnout for academic neurology faculty. We hypothesize PL does not impact academic achievements; however, women who take PL experience higher burnout. The survey was administered to 19 US academic neurology centers from 2/2021-4/2022. Participants self-reported academic achievements (rank, leadership positions, publications, funded projects, awards, and speakerships), experience of PL, family work conflict, and burnout. Groupwise comparisons and regression analyses were performed to examine the effects of PL and gender on academic achievement outcomes and on burnout. Among 239 survey participants, 155 reported taking PL (75% female) and 84 did not (NoPL; 29% female). PL faculty received fewer awards (p=0.018) and experienced greater family-work conflict (p<0.001) than NoPL faculty. No significant group differences were found with other achievement metrics. Among PL faculty that had children, PL women had significantly lower numbers of first/last author publications compared to PL men (p=0.020). When holding rank constant, PL women received awards at rate 1.2 times that of NoPL women, while PL men received awards at rate of 0.34 times that of NoPL men. When holding rank constant, PL women are 6.7 times more likely to experience moderate emotional exhaustion compared to PL men. Parental leave disproportionately affects women and men with respect to academic achievement and emotional exhaustion. In principle, PL is meant to provide support to faculty during a major life event, but the current climate in academic neurology is such that PL policies fall short of this. More work is necessary to resolve existing inequities in academic neurology, provide greater support for working parents, and develop more equitable PL policies.Item Standardizing Treatment for Acute Exacerbations of COPD (AECOPD) at a Large Academic Hospital(2024-01-30) Peraka, Veena; Wootton, Taylor; Irving, AnnetteBACKGROUND: Acute exacerbations of COPD (AECOPD) are a common problem faced by patients with chronic obstructive pulmonary disease (COPD). There are discrepancies in AECOPD treatment that impact patient outcomes. Despite evidence of improved or non-inferiority outcomes and reduced cost with short oral regimens, steroid prescribing patterns remain variable. Furthermore, there is confusion regarding antibiotic choice that contributes to the problem. LOCAL PROBLEM: The local problem is the lack of standardization of care for AECOPD at Clements University Hospital (CUH). Data from 6/1/2021-5/31/2023 shows that AECOPD treatment at CUH has been variable despite the availability of evidence-based medications. AIM: The aim of this project is to improve the adherence to evidence-based selection of steroids and antibiotics for AECOPD at CUH by 75% at 1 year after the intervention along with a 10% decrease in length of stay and readmissions. METHODS: The intervention is an order set containing guidelines and treatments for AECOPD that can be implemented into Epic electronic health records. Emergency department physicians, hospitalists, and pulmonologists were consulted for insight about treatment recommendations. This advice along with the GOLD guidelines and additional research were used to create the order set. RESULTS: The order set is now ready for implementation into Epic after being presented to physicians and respiratory therapists for feedback. After implementation, data will be collected on the usage and effectiveness of the order set and analyzed for up to one-year post-intervention. CONCLUSION: AECOPD is a complex disease that is treated with various medications that can lead to the different outcomes. Insight from various physician specialties was helpful to understand methods at CUH at different stages of the AECOPD journey. Due to the complexity, the order set can be a helpful resource for physicians when choosing treatments to improve adherence to evidence-based medications and patient outcomes.Item Systematic Review of the Global Literature on Uncomplicated Recurrent Urinary Tract Infections: Underscoring Major Heterogeneity(2024-01-30) Papp, Sara B.; Seyan, Zheyar; Khan, Zara; Kenee, Parker R.M.; Christie, Alana; Zimmern, Philippe E.INTRODUCTION: Urinary tract infections (UTI) are common infections affecting over 60% of women and often become recurrent (rUTI). Despite their prevalence, research on rUTIs is limited and results are heterogenous due to varying definitions and populations. This systematic review examines global literature on uncomplicated rUTI and assesses differences in data based on geographic region. METHODS: Databases PubMed, Embase, WHO Global Index Medicus, and SciELO were searched for the keywords and/or MESH terms for recurrent and UTI, 2000- 2023. Studies were restricted to females ≥18 with uncomplicated rUTIs. Studies were excluded if they did not provide a definition for rUTI or did not cite/report an estimate for rUTI prevalence. The review was registered in PROSPERO and conformed to PRISMA. RESULTS: The search yielded 2,947 studies of which 124 were included (Table 1). Most studies were conducted in Europe (41%) or North America (39%), were prospective (52%), at tertiary centers (49%) and included all age groups (60%). Public institutions were the most common in North America (67%) while multi-center and public institutions were equally frequent in Europe (39% each). The most common definition for rUTI was 2 UTI/6m or 3 UTI/1y (62%). Regardless of study location, most studies cited prevalence estimates for rUTI from U.S.-based populations. Convenience samples were used for 91% of studies and sample sizes were: 30% n<50, 29% n=50-99, 22% n=100-199, 36% n≥200. CONCLUSIONS: This study represents the first formal investigation of the global literature base on uncomplicated rUTI. Studies on rUTIs are globally of small scale and definitions used for rUTI are heterogeneous. More studies are needed to ascertain the true prevalence of rUTI outside of North America and Europe.Item Training through a Novel Community-Engaged Research Project to Reduce Pregnancy-Associated Morbidity and Mortality from Maternal Sepsis in New York City(2024-01-30) Zhao, Alice; Richardson, Briana; LaHote, Jessica; Oktem, Ayda; Plumlee, Austin; Hall, Kelli StidhamMaternal sepsis is the second-leading cause of maternal mortality in the U.S., with a disproportionate impact among racial and ethnic minorities. Although maternal sepsis is largely preventable, there remains little evidence concerning the management of risk factors to ensure safe and equitable maternal care during delivery and transition to postpartum. The EnCoRe MoMS study (Engaging Communities to Reduce Morbidity from Maternal Sepsis) is a comprehensive, community-engaged project focused on reducing pregnancy-associated sepsis risk and promoting maternal health equity in NYC. Community stakeholders are integrated in the community research design process through the Community Organization Leadership Advisory Board (CoLAB). I aimed to contribute to the qualitative portion of the ongoing EnCoRe MoMS study to better understand how the social determinants of health impact the lived experiences of patients and how qualitative interviewing can uncover specific barriers and proposed solutions that may be implemented across the pregnancy continuum. We developed an efficient workflow for the recruitment, consent, and enrollment of patients, then conducted qualitative in-depth interviews (IDIs) with postpartum patients and community focus group discussions (FGDs). Major themes explored during IDIs included prenatal and labor/delivery experiences, facilitators/barriers to accessing quality maternal care, respectful care, community-based resources and solutions, etc. (see table). Ultimately, qualitative data collection through IDIs and the FGD allowed us to observe the lived experiences of patients at high risk of pregnancy and postpartum complications, including sepsis.