Medical College Of Georgia Research Articles

Promoting Patient Care Ownership in Medical Students through Standardized Simulations

Background:Professional identity formation (PIF) has been demonstrated to play an important role in medical students' transition from a peripheral role into becoming a physician that bears primary responsibility for the care of their patients1,2. Multiple factors influence this development, including clinical experiences as well as sociocultural, familial, academic, moral, religious, and gender-based roles, values, beliefs, and obligations. Many of these factors can be emulated in simulations to encourage this merging of identities; the most critical of which is patient care ownership (PCO)6. This study was conducted on the 4th year medical students at the Medical College of Georgia (MCG) and compares a self-reported PCO index score amongst the various subsets. These include main vs regional campus assignment for clinical years, gender identity, ethnicity, and prior healthcare experience before medical school. Methods:For this study, we distributed a questionnaire developed by Avey et al. (2009) and adapted by Wyatt et al.11 (2023) to evaluate the feelings and opinions of medical students regarding their level of patient care ownership11,16,17. To evaluate the effects of the longitudinal simulation curriculum on PCO as measured with the survey instrument index scores, independent sample t-tests and ANOVA between different groups with a Tukey HSD multiple-comparison post-hoc were done. Groups analyzed for differences included campus, gender identity, race, ethnicity, and prior experience in the healthcare field. Results: A total of 201 students were invited to participate in this study. There was no statistically significant difference between students from main and regional campuses in PCO index scores. When comparing between gender identities of male, female, and nonbinary, there was no significant difference (p = 0.248). Comparing ethnicities did not show any significant differences (p = 0.936). Finally, there was no significant difference in PCO index scores between students in regard to their prior healthcare experiences (p = 0.155). Conclusion:This study highlights the importance of a comprehensive and intentionally-designed simulation curriculum to prompt PCO in order to facilitate PIF prior to residency, for the purpose of producing more confident and competent intern physicians2. Conflict of interest: none Treatment of human and animal subjects: not applicable

Reasons for patients keeping or missing their appointments in family medicine in the United States: importance of no-show history in the previous year

Background Missed appointments at primary care clinics are detrimental to patients' health and clinics' efficiency. We investigate reasons for no-shows, motivation to keep appointments and self-perception of health among patients with different no-show histories. Methods Using archival data of patient visits (2018-2020) at Medical College of Georgia (MCG) Family Medicine Clinic (FMC) at Augusta University, we categorized patients based on the number of no-shows in the previous calendar year (Group 1 = zero; Group 2 = one or two; Group 3 = three or more). We gathered descriptive statistics on patient age, race, gender and insurance type and performed a regression analysis to estimate these factors' impact on the likelihood of shifting between groups. We administered FMC patients an anonymous survey on reasons for no-shows, motivations to keep appointments and self-perception of health. Results Patients in Group 1 versus Groups 2 and 3 differed in self-perception of health and the presence of a household dependent. Reasons for no-shows indicate difficulties with timing of appointment and change in health status and suggest an association between no-shows and health status. The main motivation to keep the appointment in all three groups was health concerns. Conclusions This study highlights the importance of distinguishing patients based on no-show history when designing no-show reduction interventions.

Novelty preference assessed by eye tracking: A sensitive measure of impaired recognition memory in epilepsy

ObjectiveEpilepsy patients often report memory deficits despite normal objective testing, suggesting that available measures are insensitive or that non-mnemonic factors are involved. The Visual Paired Comparison Task (VPCT) assesses novelty preference, the tendency to fixate on novel images rather than previously viewed items, requiring recognition memory for the “old” images. As novelty preference is a sensitive measure of hippocampal-dependent memory function, we predicted impaired VPCT performance in epilepsy patients compared to healthy controls. MethodsWe assessed 26 healthy adult controls and 31 epilepsy patients (16 focal-onset, 13 generalized-onset, 2 unknown-onset) with the VPCT using delays of 2 or 30 s between encoding and recognition. Fifteen healthy controls and 17 epilepsy patients (10 focal-onset, 5 generalized-onset, 2 unknown-onset) completed the task at 2-, 5-, and 30-minute delays. Subjects also performed standard memory measures, including the Medical College of Georgia (MCG) Paragraph Test, California Verbal Learning Test-Second Edition (CVLT-II), and Brief Visual Memory Test-Revised (BVMT-R). ResultsThe epilepsy group was high functioning, with greater estimated IQ (p = 0.041), greater years of education (p = 0.034), and higher BVMT-R scores (p = 0.024) compared to controls. Both the control group and epilepsy cohort, as well as focal- and generalized-onset subgroups, had intact novelty preference at the 2- and 30-second delays (p-values ≤ 0.001) and declined at 30 min (p-values > 0.05). Only the epilepsy patients had early declines at 2- and 5-minute delays (controls with intact novelty preference at p = 0.003 and p ≤ 0.001, respectively; epilepsy groups’ p-values > 0.05). ConclusionsMemory for the “old” items decayed more rapidly in overall, focal-onset, and generalized-onset epilepsy groups. The VPCT detected deficits while standard memory measures were largely intact, suggesting that the VPCT may be a more sensitive measure of temporal lobe memory function than standard neuropsychological batteries.

Change processes to transform health professions education: A medical education conference organized by the Educational Innovation Institute of the Medical College of Georgia, Augusta University and hosted on Twitter.

BackgroundWithin the steady stream of innovations and reforms to medical education curriculum lies the commonality of change management. Change management is a complex, multifactorial construct that can either ensure the success or prevent the adoption of an innovation. Furthermore, change management is a process rather than an event. As such, it is critical to integrate longitudinal, systematic evaluation and organizational support into the implementation strategy for any innovation.PurposeThe purpose of this innovation was to support the implementation of a curriculum redesign at the Medical College of Georgia (MCG). This rigorous study used a validated framework, the Concerns-Based Adoption Model (CBAM), to measure the change management process. The purpose of this study was to both document and disseminate benchmarks and developments for other medical colleges embarking on curriculum reform, but, more importantly, to use the data collected during the study to support and refine the change management process at MCG.ResultsTwo years of data have been collected in each of the diagnostic dimensions, and the results have been reported to stakeholders at MCG. As a result, changes have been made to the implementation process.

Adapting Education at the Medical College of Georgia at Augusta University in Response to the COVID-19 Pandemic: the Pandemic Medicine Elective.

The Medical College of Georgia (MCG) responded to the COVID-19 pandemic’s challenges to medical education with a novel, comprehensive curriculum. The Pandemic Medicine Elective was an effective solution with a safe, virtual alternative to traditional clinical experiences. As the elective evolved to include pre-clinical students and service initiatives across Georgia, students and faculty navigated online platforms to execute critical community-based projects. This curricular development utilized an interdisciplinary approach by faculty across each of MCG’s regional campuses. We describe the curriculum of the electives, the student initiatives, and lessons learned while quickly adapting curriculum during the COVID-19 pandemic.

Histology Retention in a Medical School Curriculum

IntroductionPoor retention of medical knowledge is a concern within medical education. While studies show that student retention from basic science disciplines often follows the “forgetting curve”, histology retention has not been examined independently of other anatomical sciences. Investigation of histology retention is of increasing importance as medical education moves towards integrated curricula with the use of technological advances in the classroom, such as virtual microscopy. The purpose of this study was to evaluate histology retention of first‐year students at the Medical College of Georgia (MCG).AimsThe specific aims of this study include evaluating the relationships of 1) histology retention and academic performance 2) retention intervals (RI) to histology retention and 3) histology retention and students’ previous exposure to histology as well as their modality of study.MethodsAcademic performance data from histology quizzes and exams were collected from first‐year medical students at MCG from the Class of 2022 (n=171). A histology comprehensive assessment was administered at the end of the academic year to assess histology knowledge retained throughout first‐year histology curriculum. Students were also surveyed on their prior histology experience and study method modality. A linear regression analysis was performed to determine if there was a correlation between academic performance and retention. A comparison of means was used to assess the relationship between histology retention scores compared to academic performance in terms of RI, histology exposure, and modality of study. Paired sample t‐tests were used for analyses. IRB approval (exempt) was obtained from Augusta University.ResultsFirst‐year medical students at MCG were found to only retain 52.4% ± 17.0% of histology content on the end of year comprehensive assessment. Academic performance in histology did not predict retention at the end of the academic year (R=0.27). Student retention dropped on average from 84% to 52% regardless of RI length (2, 3, 5, or 6 months). No significant difference was found between students with prior histology exposure (85.9% ± 4.9%) and those without (84.2% ± 5.3%) on overall histology grade averages. However, those with prior histology experience did score significantly better on the comprehensive assessment (58.5% ± 15.3% vs. 51.2% ± 17.2%; p=0.04). No significant difference was seen on average histology grades (84.5% ± 4.2%, 84.2% ± 16.6%) or comprehensive assessment performance (52.9% ± 6.9%, 51.4% ± 17.8%) when study modalities (virtual microscopy vs physical slides) were compared.Discussion and ConclusionsThis data supports previously reported findings that medical students retain on average ~50% of their basic science knowledge. These findings also demonstrate that academic performance is not a predictor of retention. Furthermore, RI and method of study appear to have no significant impact on histology retention. However, prior histology experience appears to aid in retention and suggest that more testing/re‐exposure during the academic year could increase histology retention. These results may be useful in informing educators in medical education and help to guide reform for better retention outcomes from pre‐clinical medical curricula.

Founding Physicians of the Medical College of Georgia and Their Connections to Crawford Long and the First Surgical Anesthetic

Milton Antony (1789-1839), an apprenticed trained physician, began educating medical apprentices in 1826 and helped to establish the Medical College of Georgia (MCG) in 1829. Antony recruited additional faculty, Louis Dugas (anatomy and physiology), and Paul Eve (surgery), and together they worked to promote the dissemination of new medical knowledge and enhance and reform medical education. As a result of their efforts, the Southern Medical and Surgical Journal (SMSJ) was established in 1836. The SMSJ became the most successful and widely read regional medical journal. Unfortunately, upon the death of Milton Antony because of the Augusta yellow fever epidemic, the SMSJ ceased publication in 1839. Paul Eve then became Dean of MCG and revived the SMSJ in 1844.Crawford Long (1815-1878) administered ether anesthesia for surgical removal of a neck tumor to James Venable in 1842. For several possible reasons, he did not publish his experience with ether until after Morton’s demonstration of ether in Boston in 1846. Crawford Long did meet with Paul Eve, in Augusta at MCG, and was encouraged to publish his experiences with ether in the revived SMSJ, which he did in 1849.It is quite possible that if Milton Antony had lived, and the SMSJ had been continuously published, that Crawford Long may have published his use of ether well in advance of Morton’s ether demonstration in 1846. Had that occurred, the great controversy during the mid-nineteenth century over who first used ether for surgical anesthesia would not have existed, and Crawford Long would have received appropriate credit during his lifetime.

Analysis of Preclinical Academic Performance Compared to Matched Residency

IntroductionAs medical school enrollment has risen, the number of graduate medical education positions remains relatively unchanged. With this increased disparity, residency selection committees place heavy emphasis on USMLE Step 1 scores, clerkship grades, class rankings, and Alpha‐Omega‐Alpha membership when extending interviews and ranking applicants. The preclinical years are often overlooked in their relevance to potential residency matches but may play an important role in choosing and ultimate acceptance into a particular specialty. The purpose of this study was to assess how preclinical performance of Medical College of Georgia (MCG) graduates compared to their residency match. We hypothesized there would be academic performance differences in preclinical content areas that are typically associated with a student's residency choice.MethodsPreclinical academic performance from MCG Classes of 2017 and 2018 (n=321 students) were compared to matched residency. Residencies were categorized by relative competitiveness based on residency U.S. graduate fill rates (Highly Competitive/HC: Plastic Surgery, Orthopaedic Surgery, Otolaryngology, Ophthalmology, Radiology, Radiation Oncology, and Neurosurgery; Competitive/C: Emergency Medicine, Urology, Dermatology, General Surgery, Anesthesiology, Pediatrics, OB/Gyn.; Less Competitive/LC: Psychiatry, Pathology, Physical Medicine and Rehabilitation, Internal Medicine, Neurology, Family Medicine). ANOVA and t‐tests were used for analyses.ResultsStudents matching into highly competitive residencies performed significantly better in all preclinical courses compared to those going into competitive or less competitive residencies (p<0.05). As expected, USMLE Step 1 scores were also significantly higher for students matching in highly competitive residencies (243.7 ± 13.0) compared to other residencies (C: 231.0 ± 15.9; LC: 230.8 ± 16.3; p<0.05). Students who matched into Surgical or Radiology specialties performed significantly better in Anatomy (84.4 ± 5.6) compared to those in other specialties (82.9 ± 5.5; p<0.05). Students matching into Orthopaedic Surgery scored significantly higher than the class average for the Year 1 Tissue and Musculoskeletal System (88.9 ± 3.6 vs. 85.3 ± 5.4; p<0.01) and Year 2 Skin and Musculoskeletal System Courses (95.8 ± 1.5 vs. 92.7 ± 3.9; p<0.01). Students matching into Dermatology scored significantly higher than the class average in Pathology (92.1 ± 3.5 vs. 88.0 ± 5.4; p<0.01).ConclusionsStudents who match into highly competitive residencies need a firm foundation in the basic sciences in order to perform well on USMLE Step 1 and in the clerkships. While residencies may not look specifically at preclinical grades, more competitive programs such as Surgery specialties and Radiology place greater emphasis on class rank and overall grades, which incorporate preclinical grades. Our previous research has shown that content and performance in the preclinical curriculum do influence residency choice early in medical school. Subsequent studies will further examine how these factors are involved in residency choice.This abstract is from the Experimental Biology 2019 Meeting. There is no full text article associated with this abstract published in The FASEB Journal.

Comparative neuropsychological effects of carbamazepine and eslicarbazepine acetate

People with epilepsy are at increased risk for neuropsychological dysfunction due to multiple factors, of which the most amendable are antiseizure medications (ASMs). Antiseizure medication effectiveness is frequently determined by tolerability. In this study, we compared the neuropsychological effects of eslicarbazepine acetate (ESL) and carbamazepine immediate-release (CBZ) using a randomized, double-blind, crossover design in healthy volunteers with a 2-week titration and 4-week maintenance phase in each treatment arm (CBZ = 400 mg BID and ESL = 800 mg qAM). Neuropsychological testing was performed at the initial visit, repeated at 1st baseline nondrug condition, end treatment #1, 2nd nondrug condition one month after treatment #1, end treatment #2, and 3rd nondrug condition one month after treatment #2. Neuropsychological testing was conducted 2 h after morning dose and included computer (i.e., dual task test, selective attention test, symbol digit, verbal memory, visuospatial memory, and 1- & 2-back continuous performance) and noncomputer tasks (i.e., Medical College of Georgia (MCG) paragraph memory, Stroop, Symbol Digit Modalities Test, Profile of Mood States). z-Scores calculated from nondrug conditions were used to compare ESL and CBZ for the 23 completers. Follow-up analyses included individual test scores and distribution of individual raw means. Mean blood levels on test day were CBZ = 8.9 μg/ml and ESL = 15.3 μg/ml. Omnibus z-score was significantly better for ESL (p = .0001). For individual measures, executive function and selective attention tests were statistically significantly better for ESL. Individual test raw means favored ESL over CBZ on 22 of 30 measures (p = .016, 2-tailed sign test). Eslicarbazepine acetate demonstrated less adverse neuropsychological effects than CBZ.

Sustainable Global Health Education in Obstetrics & Gynecology: Meeting the Administrative Demands

BACKGROUND: While resident interest in global health education has increased, the administrative demands of providing a meaningful and safe international experience have also grown. In 2012, the Department of OBGYN at the Medical College of Georgia (MCG) established a global women’s health program, including an international rotation. METHODS: After constructing a program outline, identifying stakeholders, establishing educational goals and objectives, and determining available resources, an educational program in global women’s health was developed. Barriers related to finance, educational structure, and personal/professional liabilities were resolved. ACGME requirements were reviewed, including: 1) supervision; 2) establishment of competency-based goals and objectives; and 3) evaluation. A program letter of agreement was signed with the international practice site. RESULTS: Since program inception, 88% of eligible residents (16 of 18) have completed the educational modules and international rotation, averaging 4 weeks abroad. Educational goals and objectives are based on epidemiology related to global health and disease-specific clinical practice. Residents complete online modules and participate in weekly departmental conferences via videoconference. Residents log procedural data and duty hours while abroad. A competency-based evaluation is completed by the supervising physician. The average cost per resident for travel, insurance, and housing is $2,416, paid by the department. The supervising physician is compensated by the department. MCG pays resident salary and benefits while abroad. DISCUSSION: As popularity for global health education has grown, the administrative requirements have become prescriptive to ensure a meaningful educational experience.

A departmental initiative for clinical and translational research

To encourage departmental research activities, the Department of Medicine of the Medical College of Georgia (MCG) introduced an internally funded Translational Research Program (TRP) in 2014. Patterned after the Vanderbilt...

Teaching anatomy in an integrated medical curriculum: getting to the heart of the matter (88.4)

In 2009, the Year 1 curriculum at the Medical College of Georgia (MCG) underwent significant curricular reform that resulted in the creation of six integrated systems based courses. All anatomical sciences are now taught as integrated components of these courses with content distributed throughout the academic year. Programatic learning objectives were also revised around this time to align competency based objectives under the six domains of Medical Knowledge, Professionalism, Communication, Practice‐Based Learning, Patient Care, and Systems‐Based Practice. To facilitate practice and assessment of these competencies, a variety of learning activities such as gross anatomy lab handover reviews, peer feedback & self‐reflection exercises, student group presentations, and histology lab quizzes were introduced. Analysis of student performance on these activities indicates that students need and appreciate opportunities to practice these competencies. Indicators of faculty productivity, such as research funding and number of publications, were analyzed as well and did not show a decline. Student perceptions of overall teaching effectiveness also increased.

Gene L. Colborn (1935–2011)

Gene L. Colborn (1935–2011)

Academy of Operative Dentistry Hollenback Memorial Prize

Dr Mackert is professor in the Department of Oral Rehabilitation, School of Dentistry, Medical College of Georgia (MCG), Augusta, Georgia. He holds joint appointments in the Department of Oral Biology and the School of Graduate Studies. He has conducted research on dental amalgam and ceramic materials and has received $2.8 million in NIH funding as a principal investigator and more than $1 million as co-investigator. He has published 45 papers in refereed journals, 11 chapters and monographs in books and symposium proceedings and 66 abstracts. In addition, he has testified twice before Congressional committees and before legislative and policymaking bodies in multiple states on the safety of dental amalgam. He is first author of a monograph on mercury exposure from dental amalgam fillings that was published by the World Health Organization. Dr Mackert has been interviewed on the amalgam controversy by Time magazine, U.S. News & World Report, The Washington Post, the Wall Street Journal, National Public Radio, Consumer Reports, The Boston Globe, USA Today, Harper's Bazaar, Redbook, Men's Health magazine, Fitness magazine, McCall's magazine and other media outlets.He received his DMD degree in 1976 from the MCG School of Dentistry and his PhD in materials science in 1979 from the School of Engineering and Applied Science of the University of Virginia. After a one-year visiting lectureship at the Gifu College of Dentistry (now Asahi University School of Dentistry) in Japan, Dr Mackert joined the faculty of the MCG School of Dentistry in 1980. In 1992, Dr Mackert was a visiting scientist in the Ceramics Processing Research Laboratory at the Massachusetts Institute of Technology.Dr Mackert is a member of Omicron Kappa Upsilon, the American Dental Association and the International Association for Dental Research. He is a fellow in the Academy of Dental Materials and the International College of Dentists. He is a Distinguished Alumnus of the MCG School of Dentistry and recipient of a Presidential Citation from the American Dental Association. He has served on the Oral Biology and Medicine Study Section and the Special Grants Review Committee of the National Institute of Dental and Craniofacial Research, the Council on Scientific Affairs of the American Dental Association, the Scientific and TechnicalAdvisory Board of Quackwatch, Inc and other advisory panels. He has presented 51 invited lectures at local, national and international venues, including the 1990 NortonMRossMemorial Lecture at theAmerican Dental Association.The Academy of Operative Dentistry is pleased to present the 2010 Hollenback Prize to Dr J Rodway Mackert, Jr.

Immersing Practitioners in the Recovery Model: An Educational Program Evaluation

The ascendance of the recovery movement in mental health care has led to the development and implementation of educational curricula for mental health providers to assist in mental health care system transformation efforts. The Medical College of Georgia (MCG) partnered with the Georgia State Department of Human Resources (DHR) to develop, implement, and evaluate such an educational curriculum for providers within an academic medical institution. This effort, entitled Project GREAT, led to the creation of a curriculum based on the SAMHSA-defined (2006) critical components of recovery. As an initial evaluation of educational curriculum effectiveness, the authors examined effects of the training program on recovery-based knowledge and recovery-consistent attitudes. We also compared MCG provider knowledge and attitudes to those of a similar group of providers at a neighboring medical institution who did not receive the intervention and training. Findings generally supported the effectiveness of the intervention in increasing providers' knowledge of recovery and a shift in recovery-supporting attitudes.

Diagnostic complication and molecular characteristics of Hb SC-Chicago disease with α-thal-2 (-α3.7 deletion): effects of multiple variant on patient’s phenotype

Dear Editor, Co-inheritance of α and β chain variants are not uncommon and mostly influence the molecular interactions of hemoglobin (Hb) tetramers, create complex genotype/ phenotype syndromes or diseases with unpredictable phenotypes. Detection of Hb variants currently utilizes techniques such as electrophoresis, high-pressure liquid chromatography (HPLC), and DNA-based methods [1]. However, these methods sometimes have limitations, and protein-based methods alone create diagnostic difficulties by misrepresenting the true extent of genotypic variations. Here, we report a subject that simultaneously inherited four globin gene abnormalities with a genotype heterozygous for alpha thalassemia-2 (α-thal-2)-α deletion, alpha chain variant Hb Chicago (α2136 [H19] Leu→Met), and two beta chain variants Hb CS (β6 [A3] Glu→Lys/Glu→Val) leading to Hb SC-Chicago-α-thal-2 (-α deletion) disease and discuss molecular characteristics as well as genotype/ phenotype correlations. The patient, presented to the pediatric clinic at the Medical College of Georgia (MCG), was a 3-year-old African American male with known SC disease. Hb Chicago and α-thal-2 are not detectable with conventional screening methods, such as complete blood count (CBC) and electrophoreses, and may thus lead to misdiagnosis of phenotypic disorders [5, 9]. The patient genotypically inherited four different abnormalities while phenotypically presented Hb SC disease. Born without complications, the patient developed seizure-like episodes at 3 weeks of age and was evaluated by a pediatric neurologist. Subsequent electroencephalogram (EEG) and physical examinations revealed a well-developed, wellnourished, active child with no remarkable findings and no relapse of seizures after the initial episode. CBC lab results revealed Hb 11.3 g/dL, Hct 35.2%, mean corpuscular volume (MCV) 64.8 fl, mean corpuscular hemoglobin (MCH) 20.8 pg, mean corpuscular hemoglobin concentration (MCHC) 32.1 g/dl, and reticulocyte 1.7%. Family history was significant for a mother with Hb AC, a father with HbAS-Chicago, and a paternal grandmother with HbAChicago. Since family evaluation showed a complex picture, blood samples were collected (in a test tube with ethylenediaminetetraacetic acid (EDTA)) from available family members and patient and sent to the Titus HJ Huisman hemoglobinopathy laboratory at the MCG, Augusta, GA, USA, for further testing. The patient’s father was not available for testing. Informed consent was obtained from patient’s mother. Red cell lysates were analyzed by isoelectric focusing (IEF) and two types of HPLC (cation exchange and reverse phase), utilizing the methods reported earlier [1].A theoretical three-dimensionalmolecularmodel of Hb SC-Chicago has been designed by using research collaboratory for structural bioinformatics protein data bank code 1FHD (Hb molecule) as a template on RasWin Molecular Graphics Windows V2.7.4.2 molecular software. DNA was isolated from the patient and paternal grandmother’s peripheral blood to perform DNA analyses. Sequencing of β, α, and α globin genes were done utilizing the methods described earlier [2, 3]. Since MCV and MCH values of the patient were lower than expected for a typical SC disease and also incidence of α-thal-2 is very high in the African Ann Hematol (2009) 88:1151–1153 DOI 10.1007/s00277-009-0740-8

Counseling Center-Based Tele-Mental Health for Students at a Rural University

Students attending rural academic institutions often have no immediate access to psychiatrists to supplement on-site Counseling Center (CC) services. Because the Medical College of Georgia (MCG) could not cost-effectively provide on-site psychiatry services to Georgia Southern University (GSU) students, the two institutions explored telehealth services delivered by supervised Psychiatry residents using Web-based videoconferencing on MCGs virtual private network. GSU counselors completed client severity rating forms. CC clients in ongoing therapy who were judged to be in need of psychiatric services were referred to the Tele-clinic (TC). CC counselors referred the most challenged students to TC according to total distress score on intake, clinician intake assessment of client difficulty, and client need for medications. After seeing the clients in TC, MCG residents also completed GSU CC client severity rating forms. Post-intake and satisfaction surveys already in use at the GSU CC were completed both by CC clients not in TC and by CC clients jointly enrolled in TC. TC and CC populations were compared by gender, race, past mental health treatment, past psychiatric hospitalization, and past and current use of psychotropic drugs. Telepsychiatry conducted using low bandwidth videoconferencing successfully supplemented GSU CC mental healthcare, especially for clients with the most serious problems, and did so without travel from campus and within the milieu of daily student life. Cost-effective telepsychiatry services can successfully supplement management of students with mental health issues who attend rural, smaller, and/or resource-challenged academic institutions.

Use and Abuse of Proton Pump Inhibitors

Purpose: To determine the utilization of proton pump inhibitors (PPIs) at an academic medical center we evaluated the indications for PPI use in hospitalized patients, and the frequency in which patients placed on a PPI during hospitalization were discharged on a PPI. Methods: We performed a prospective analysis of 502 consecutive patients admitted at the Medical College of Georgia (MCG) and the Children's Medical Center (CMC) who received a PPI. Patients who were on a PPI at home and not placed on one at the time of admission were not accounted for in this study. We recorded demographics, indication for use, hospital service prescribing PPI, route of administration, PPI use prior to admission, and discharge PPI medication for each admission. Results: Between May 6th and June 19th, 2005, a total of 2,497 patients were admitted to MCG and CMC. 502 were prescribed a PPI. Analysis of the adult population revealed 463 (26%) patients admitted to MCG were prescribed a PPI. Patients received a PPI for the following indications: stress ulcer prophylaxis (SUP)-53%, GERD-30%, not documented -15%, GI bleed-5%, continuation of home medication-4%, other-4%, esophagitis-0.1%, and peptic ulcer disease-0.1%. 37% of patients were on a PPI prior to admission. Although 246 patients (53%) were placed on a PPI for prophylactic purposes, only 18% were admitted to the intensive care unit. Overall, 300 of the 463 patients (∼65%) were prescribed a PPI without a documented appropriate indication. Upon discharge, 50% of patients were prescribed a PPI. 22% of patients placed on a PPI for prophylactic purposes were discharged on a PPI. Overall, about 55% of patients were discharged on a PPI without appropriate indication or documentation. Conclusion: There is significant overuse of PPIs in the inpatient setting at our institution with about 26% of patients receiving a PPI on admission, and 55% of patients discharged on a PPI without any clear indication or documentation. Caution must be used when initiating PPI therapy in the hospital setting; long-term therapy often continues unnecessarily after discharge leading to increased healthcare costs, polypharmacy, and increased risk for potential adverse effects including Clostridium difficile diarrhea, community-acquired pneumonia, and intestinal bacterial overgrowth. Therefore, physicians need to be aware of the indications and possible consequences of PPI use in hospitalized patients.

Comparison of the Effectiveness of Two Lecture Methods in an OB/GYN Clerkship

DOI: http://dx.doi.org/10.5915/39-4-8525 Background: A structured, consistent, didactic lecture system is extremely important in a third-year medical clerkship. Yet, its development for the obstetrics/ gynecology (OB/GYN) program is challenging for many reasons. Development of a system that is less dependent on a given lecturer's availability yet still provides complete coverage of the Association of Professors of Gynecology and Obstetrics (APGO) topics for third-year students is desirable. Objective: The present study was designed to compare the effectiveness on third-year OB/GYN medical students of live lectures versus lectures previously recorded to a compact disc. Outcome measures were a midterm internal examination and the National Board of Medical Examiners (NBME) examination scores at the end of the clerkship. Experimental Design: Third-year medical students were assigned by lottery either to the Medical College of Georgia (MCG) campus in Augusta, Georgia, or one its several community-based sites (CBSs) throughout the state of Georgia. All third-year clerkship lectures given by different instructors were videotaped and saved to a compact disc to be played at all CBSs. The students at CBSs were required to observe the lectures in the same order as the live lectures were delivered to students at the MCG campus in Augusta. Results: Student performance on the midterm internal exam and on the NBME examination was compared between the MCG campus and CBSs. Results are shown as raw score mean (SD). Midterm results showed: MCG was 65.6 (8.7) and CBS was 70.4 (17.0). NBME results showed: MCG was 81.1 (6.3) and CBS was 82.2 (7.6). Conclusion: Using examination scores as the outcome, our preliminary data suggest there may be no significant difference in performance on the shelf exam between students receiving a live lecture versus students observing the same lecture electronically.

Do medical students respond empathetically to a virtual patient?

Background Significant information exchange occurs between a doctor and patient through nonverbal communication such as gestures, body position, and eye gaze. In addition, empathy is an important trust-building element in a physician: patient relationship. Previous work validates the use of virtual patients (VP) to teach and assess content items related to history-taking and basic communication skills. The purpose of this study was to determine whether more complex communication skills, such as nonverbal behaviors and empathy, were similar when students interacted with a VP or standardized patient (SP). Methods Medical students (n = 84) at the University of Florida (UF) and the Medical College of Georgia (MCG) underwent a videotaped interview with either a SP or a highly interactive VP with abdominal pain. In the scenario, a life-sized VP was projected on the wall of an exam room in SP teaching and testing centers at both institutions. VP and SP scripted responses to student questions were identical. To prompt an empathetic response (ie, acknowledging the patients’ feelings), during the interview the VP or SP stated “I am scared; can you help me?” Clinicians (n = 4) rated student videotapes with respect to nonverbal communication skills and empathetic behaviors using a Likert-type scale with anchored descriptors. Results Clinicians rated students interacting with SPs higher with respect to the nonverbal communication skills such as head nod (2.78 ± .79 vs 1.94 ± .44, P < .05), and body lean (2.97 ± .94 vs 1.93 ± .58, P < .05), level of immersion in the scenario (3.31 ± .49 vs 2.26 ± .52, P < .05), anxiety (1.16 ± .31 vs 1.45 ± .33, P < .05), attitude toward the patient (3.24 ± .43 vs 2.89 ± .36, P < .05), and asking clearer questions (3.06 ± .32 vs 2.51 ± .32, P < .05) compared to the VP group. The students in the SP group also had a higher empathy rating (2.75 ± .86 vs 2.16 ± .83, P < .05) and better overall rating (4.29 ± 1.32 vs 3.24 ± 1.06, P < .05) than the VP group. Empathy was positively correlated with the observed nonverbal communication behaviors. Eye contact was the most strongly correlated with empathy ( r = .57, P < .001), followed by head nod ( r = .55, P < .001) and body lean ( r = .49, P < .001). Conclusions Medical students demonstrate nonverbal communication behaviors and respond empathetically to a VP, although the quantity and quality of these behaviors were less than those exhibited in a similar SP scenario. Student empathy in response to the VP was less genuine and not as sincere as compared to the SP scenario. While we will never duplicate a real physician/patient interaction, virtual clinical scenarios could augment existing SP programs by providing a controllable, secure, and safe learning environment with the opportunity for repetitive practice.