Medical College Of Pennsylvania Research Articles

Impact of USMLE Step 1 Transition to Pass/Fail Scoring System on Medical Students' Anxiety, Sleep Quality, and Burnout

BACKGROUND: Originally designed to evaluate the application of foundational scientific knowledge in clinical contexts, the United States Medical License Exam Step 1 evolved into a comparative tool for assessing candidates' educational foundations. This transition heightened the pressure on medical students to excel in the exam. In response, collaborative efforts involving the National Board of Medical Examiners prompted a significant change from reporting scores to a pass/fail system. However, the true impact of this shift remains insufficiently explored. This study aims to assess the emotional toll - encompassing burnout, anxiety, depression, and sleep quality - experienced prior to taking the Step 1 exam. Additionally, it aims to uncover potential gender-based disparities in perceived stress, anxiety, and depression. METHODS: The study encompasses the entirety of third-year medical students at Drexel University College of Medicine, who were invited to participate in a comprehensive survey. Drawing from retrospection, the survey relies on self-reported data regarding anxiety, depression, sleep quality index, and burnout levels. Data compilation was anonymized and executed through the Qualtrics platform. RESULTS: A total of 102 medical students completed the survey, with a 97% pass rate for the USMLE Step 1. Despite their excellent performance, 75% of students reported inadequate sleep quality, and 68% exhibited mild to moderate anxiety levels. Among them, a higher percentage of females (83%) experienced mild to moderate anxiety compared to their male counterparts (50%). Furthermore, 66% of students felt that their commitment to education exceeded what was reasonable for their well-being. CONCLUSION: The transition from traditional scoring to a pass/fail system was ostensibly intended to enhance the mental well-being of medical students. Nevertheless, our findings underscore that students continue to grapple with heightened levels of stress, anxiety, and burnout during the pivotal month leading up to the Step 1 examination.

Undue Burden the Medical School Application Process Places on Low-Income Latinos

Undue Burden the Medical School Application Process Places on Low-Income Latinos

69 Influence of Cardiovascular Risk Factors on Neuropsychological Trajectories in Black/African American Adults Living with HIV

Objective:Human immunodeficiency virus (HIV) type 1 (HIV-1), cardiovascular disease, and HIV-associated neurocognitive disorders (HAND) disproportionately affect Black/African American individuals compared to other racial and ethnic groups. Understanding the mechanisms of cognitive health disparities is essential for developing policy and health interventions to combat such disparities. Cardiovascular risk factors/diseases are common comorbidities that likely contribute to cognitive health disparities among Black/African American people living with HIV (PWH), but their impacts on cognition longitudinally in this population are unclear. The current study examines the relationship between cardiovascular risk and cognitive functioning over time in Black/African American adults living with HIV.Participants and Methods:A sample of 122 Black/African American adults with HIV (ages 25-68, M=51.8, SD=7.7; 98% on antiretroviral therapy; 91% with undetectable viral load) were selected from the Drexel/Temple Comprehensive NeuroHIV Center, Clinical and Translational Research Support Core (CTRSC; based at Drexel University College of Medicine) Cohort. They completed longitudinal visits (300 total visits, average follow-up time=4.9 years) that included clinical interviews, medical record review, biometric measurements, and comprehensive neuropsychological assessments. Cardiovascular risk factors of interest were body mass index (BMI), waist-to-height ratio (WHtR), and a total vascular risk burden score (VBS) representing five risk factors: obesity, central obesity, diabetes, hyperlipidemia, and hypertension. Based on a prior principal component analysis, three cognitive domains were examined: (1) verbal fluency, (2) visual memory/visuoconstruction, and (3) motor speed/executive functions. Mixed models were used to examine domain-specific cognitive trajectories in relation to baseline cardiovascular risk factors and changes in cardiovascular risk factors.Results:Overall, cognitive test performance improved over time (p<.003). Baseline VBS was marginally associated with longitudinal change in verbal fluency (p=.06). Participants with low baseline VBS (0-1 risk factors) demonstrated improvement in verbal fluency (p=.002), while those with higher VBS (2-5 risk factors) demonstrated stability in verbal fluency. In contrast, greater increases in BMI and in WHtR predicted more favorable trajectories in motor speed/executive function (both p<.001). Patients with increasing BMI over time improved in this domain (p=.02), while patients with stable or decreasing BMI did not. A similar pattern was observed for WHtR change. No vascular risk factors were associated with trajectories of visual memory/visuoconstruction.Conclusions:Higher total vascular risk burden was associated with less favorable verbal fluency trajectories, reflecting the negative cognitive consequences of disorders such as diabetes, hyperlipidemia, and hypertension. Unexpectedly, greater increases in BMI and WHtR were associated with more favorable trajectories in motor speed and executive functioning. In this population, weight gain may be a proxy for other positive health factors, such as immune reconstitution, which will be examined in future analyses. Taken together, cardiovascular risk factors have heterogeneous associations with cognitive trajectories, emphasizing the importance of examining the mechanisms of these varying relationships. Future research will examine how social determinants of health, such as racial/ethnic discrimination, contribute to disparities in cardiovascular risk factors and cognitive outcomes.

Temporal Reinforcement of Naloxone Training Results in Significant Retention of Anti-bias and Overdose-Response Knowledge.

The opioid epidemic is an increasingly severe problem affecting public health and leading to significant economic burdens on healthcare systems. Overdose reversal training and de-stigmatization efforts are common strategies used to combat this epidemic.Nevertheless, healthcare professionals report a lack of confidence in administering naloxone and high stigmatization levels towardpeople with opioid use disorder (OUD).While one-time educational training reduces stigma and improves naloxone administration confidence, we previously demonstrated that knowledge retention at a three-month follow-up is reduced amonga cohort of medical students. This study aimed to improve the effectiveness of opioid overdose awareness and reversal training (OOART) with a three-month follow-up abbreviated OOART (aOOART) booster video. Voluntary OOART was offered to first-year medical students (M1) at the Drexel University College of Medicine in 2022.At this training, 82 students completed a pre-training survey to establish a baseline knowledge and attitude towardpeople with OUD and their familiarity with the steps to reverse an opioid overdose. Following the hour-long training, 64 of 82 (79%) participants completed the post-training survey to measure the immediate retention of training information. After 2.5 months, students were randomly selected to receive a 6.5-minute aOOART booster video or serve as an unboosted control. Students in the booster and non-booster cohorts then completed a three-month follow-up survey. Students who received the aOOART booster had significantly increased opioid reversal knowledge scores compared to non-boosted control students at the three-month follow-up.The aOOART booster resulted in a retention of the lowered stigma, and participants expressed a higher willingness to respond to an opioid overdose compared to participants who did not receive the booster video at the three-month follow-up. This study shows that an aOOART booster method improves knowledge retention following initial OOART.Further, the aOOART booster video served to maintain participants' reduced stigma towardpeople with OUD and maintained participants' willingness to respond to an opioid overdose.These results support the incorporation of an abbreviated, periodic OOART reinforcement video into opioid overdose response training nationwide. We believe this "booster video" approach is a novel and effective method to improve healthcare professionals' and medical student preparedness to render appropriate care to people with OUD.

Journey across the world to study medicine: The Anandi Joshi story.

Women faced significant barriers to pursue education in the 19th century, yet modern history has witnessed bold women overcoming insurmountable odds in this quest. To this end, Anandi Joshi braved monumental odds to successfully become the first female physician in India. Born in 1865, Anandi was one of 10 children. Her zeal for knowledge was noted early by her father, who ensured that his daughter was well-educated. She married Gopalrao Joshi as a child when she was nine; a practice that was common at the time. Anandi's quest to become a physician stemmed from a traumatic event which saw the death of her child due to the lack of medical care. Despite the numerous prevalent barriers which prevented women from indulging in education, Anandi was determined. She travelled to the United States, where through sheer persistence, she was admitted to the Women's Medical College of Pennsylvania, where she graduated with a Doctor of Medicine (MD) degree in 1886. She subsequently returned to her home country, making her the first female physician in India. Despite her untimely death, Anandi became immortalised as a legend, a beacon of hope, and continues to serve as an inspiration for generations of Indian women.

Editorial introductions.

Editorial introductions.

In Memoriam of Professor Mary E. Abood.

Cannabis and Cannabinoid ResearchAhead of Print In MemoriamIn Memoriam of Professor Mary E. AboodEugen Brailoiu, Linda Console-Bram, and Pingwei ZhaoEugen Brailoiu*Address correspondence to: Eugen Brailoiu, MD, Center for Substance Abuse Research, Lewis Katz School of Medicine at Temple University, 3500 N Broad Street, Philadelphia, PA 19140, USA. Center for Substance Abuse Research, Lewis Katz School of Medicine at Temple University, Philadelphia, Pennsylvania, USA.Search for more papers by this author, Linda Console-Bramhttps://orcid.org/0000-0003-2780-2065Pharmacology and Physiology, Drexel University College of Medicine, Wyomissing, Pennsylvania, USA.Search for more papers by this author, and Pingwei ZhaoCenter for Substance Abuse Research, Lewis Katz School of Medicine at Temple University, Philadelphia, Pennsylvania, USA.Search for more papers by this authorPublished Online:19 Apr 2023https://doi.org/10.1089/can.2023.0043AboutSectionsView articleView Full TextPDF/EPUB Permissions & CitationsDownload CitationsTrack CitationsAdd to favorites Back To Publication ShareShare onFacebookTwitterLinked InRedditEmail View article"In Memoriam of Professor Mary E. Abood." Cannabis and Cannabinoid Research, , pp. –FiguresReferencesRelatedDetails Volume 0Issue 0 InformationCopyright 2023, Mary Ann Liebert, Inc., publishersTo cite this article:Eugen Brailoiu, Linda Console-Bram, and Pingwei Zhao.In Memoriam of Professor Mary E. Abood.Cannabis and Cannabinoid Research.ahead of printhttp://doi.org/10.1089/can.2023.0043Online Ahead of Print:April 19, 2023PDF download

Deseret Hospital, Women, and the Perils of Modernization

Deseret Hospital, Women, and the Perils of Modernization

In Memoriam: Marvin Ziskin, MD, 1936–2022

It is with sorrow that we report the death of former World Federation for Ultrasound in Medicine and Biology (WFUMB) president Marvin Ziskin at the age of 86 years. A physician as well as a bioengineer, Marvin was actively involved in ultrasound research for more than 57 years. In 1965, as a research associate in Diagnostic Ultrasound at Hahnemann Medical College, Philadelphia, Pennsylvania, he pioneered the establishment of 2-D ultrasonography as a valuable diagnostic modality. In September 1965, a photograph of his laboratory featuring the ultrasonic image of a fetal head appeared on the cover of LIFE Magazine.

Personal Psychotherapy Prepares Trainees to Be Better Psychiatrists, Educators Say

Personal Psychotherapy Prepares Trainees to Be Better Psychiatrists, Educators Say

Competing Incentives: For-Profit Hospitals Add Complexity to Graduate Medical Education (Commentary).

Competing Incentives: For-Profit Hospitals Add Complexity to Graduate Medical Education (Commentary).

A longitudinal study of naloxone opioid overdose awareness and reversal training for first-year medical students: specific elements require reinforcement

BackgroundThe opioid epidemic is a progressively worsening public health crisis that continues to impact healthcare system strategies such as overdose reversal and destigmatization. Even among healthcare professionals, there remains a lack of confidence in naloxone administration and a prevalence of stigma. While training can play a major impact in reducing these shortcomings, the long-term effectiveness has yet to be characterized in training healthcare professionals. This study examined the long-term retention of opioid overdose awareness and reversal training (OOART) by evaluating performance at two-time intervals, immediately post-training and at a 3-month follow-up.MethodsVoluntary training was offered to first-year (M1) medical students at the Drexel University College of Medicine in 2021. At this training, 118 students completed training, 95 completed the post-training survey, and 42 completed the 3-month follow-up.ResultsOpioid reversal knowledge questions assessed significantly increased scores post-training and at the 3-month follow-up. In three of the attitude questions, scores were improved at both follow-up timepoints. In addition, three attitude questions indicating a participant’s confidence to respond to an opioid overdose situation increased directly after the training, but regressed at the 3-month follow-up. The remaining questions did not show any statistical difference across the survey intervals.ConclusionsThis study establishes that while OOART provides participants with the knowledge of how to respond to an opioid overdose, the retention of this knowledge at a 3-month interval is reduced. The results were mixed for longitudinal assessment of participant’s attitudes toward people with opioid use disorder. Some positive increases in attitudes were retained at the 3-month interval, while others trended back toward pre-training levels. These results support the effectiveness of the training but also provide evidence that OOART must be reinforced often.

The Making of a Community-Based Medical School Branch Campus: A Study in Healthcare System Dynamics on Medical Education Drexel University College of Medicine at Tower Health, West Reading, Pennsylvania

The Making of a Community-Based Medical School Branch Campus: A Study in Healthcare System Dynamics on Medical Education Drexel University College of Medicine at Tower Health, West Reading, Pennsylvania

"The President's Syndrome": The Diagnosis and Treatment of Gerald Ford's Lingual Actinomycosis.

Gerald R. Ford was the 38th president of the United States. He was appointed as vice president by Richard Nixon in 1974 upon the resignation of Spiro T. Agnew. In the midst of the Watergate Crisis, Nixon resigned making Ford the only president to serve without being elected as either president or vice president. In the year 2000, 13years after his abbreviated term in office, he was attending the Republican National Convention in Philadelphia where he developed pain in his tongue, slurring of his speech, and signs of a stroke. He was taken to the emergency room of Hahnemann University Hospital where a CT scan showed a posterior circulation stroke. Within 24hours, all of Ford's symptoms improved except for his tongue pain and speech. An MRI of the head and neck showed a tongue mass and he was taken to the operating room where an abscess was found. The bacteriology confirmed actinomycosis of the tongue and Ford rapidly improved after the incision and drainage. This paper will review the clinical course of Gerald Ford's lingual actinomycosis and will discuss this rare condition.

Student Perspectives on a Lab Restricted Gross Anatomy Experience During the COVID‐19 Pandemic: Lessons for the Future of Cadaveric Based Gross Anatomy Lab in Undergraduate Medical Education

INTRODUCTION/OBJECTIVEDuring the COVID‐19 pandemic, gross anatomy laboratory sessions for first year medical students at Drexel University College of Medicine were drastically altered to comply with social distancing restrictions, resulting in increased reliance on virtual resources, limited prosection access and no dissection. We evaluated student perceptions of the various instructional modalities used, importance of dissection versus prosection, and virtual versus donor‐body experiences in order to assess the value of each for gross anatomy learning.MATERIALS/METHODSGross anatomy laboratory sessions during the pandemic included both virtual (Complete Anatomy 3D software over Zoom) and prosection (rotations through stations guided by custom videos) components. An optional “Dissection Experience” was offered after the course to those who wanted to gain hands‐on skills of dissection. A voluntary IRB‐approved survey was distributed to students after completion of all gross anatomy activities. Likert‐scale (1= Strongly Disagree to 5= Strongly Agree) and slider (0= prosection/virtual resources, 100= dissection/physical resources) type questions assessed components of the gross anatomy thread and overall view of anatomy learning in medical education.RESULTSA total of 97/265 first‐year medical students completed the survey and 62% of students completed the “Dissection Experience” elective. 83% of all respondents agreed or strongly agreed that cadaveric material is essential to medical students learning anatomy. When asked about the preferred amount of prosection (0) to dissection (100) in a gross anatomy course, the responses were the following: 0‐24=8%, 25‐49=23%, 50‐74=42% and 75‐100=27%. 70% of respondents strongly agreed or agreed that they were satisfied with the prosection lab component. Only 41% of respondents strongly agreed or agreed that the virtual software was critical to their preparation for the prosection lab. 80% of respondents disagreed or strongly disagreed that cadaveric‐based anatomy teaching should be replaced by virtual/augmented reality applications or other computer‐assisted methods. When asked about the preferred amount of virtual resources (0) to physical resources such as cadaveric material or bones (100), the responses were the following: 0‐24=6%, 25‐49=5%, 50‐74=41% and 75‐100=48%.CONCLUSIONSIn a unique time of restricted lab use during the COVID‐19 pandemic, students were most satisfied with the prosection component of the course over virtual learning. Most students preferred a learning experience with cadaveric material and not fully replacing it with virtual software, and a majority of students completed an optional “Dissection Experience.” These results suggest that most students still wanted the hands‐on dissection component of anatomy learning.SIGNIFICANCEThis study demonstrates the importance of maintaining a cadaver‐based learning experience during times of restricted lab use. It also suggests that medical students may not be as satisfied with programs offering prosection only or virtual anatomy labs.

Orphaned Trainees: A Vulnerable Population in an Inequitable System

Two years ago, Hahnemann University Hospital (HUH) closed, orphaning the largest group of trainees in the history of graduate medical education (GME). Last month, the plastic surgery community learned of the forthcoming closure of two plastic surgical residencies (2.4% of all integrated plastic surgery residencies), while most programs were in the final stages of planning the 2021-2022 academic year. Recounting the turmoil experienced by orphaned HUH trainees and their families, left alone to relocate amidst funding-related legal battles, one cannot help but wonder, how could this happen again? Trainees deserve transparency, funding protection and support when training programs close or lose accreditation. Moreover, applicants deserve to know if a program is on the brink of collapse before they sign their rank list. Applicants and trainees deserve to have their funding protected in the event of a program closure, so their ability to relocate is not held hostage by a sponsoring institution. Trainees deserve to be supported by a central organization that is responsible their relocation in the event of an orphanage. These changes are overdue and their absence has already resulted in academic and emotional adversities for trainees and their families.

CORR Insights®: Is There an Association Between Bundled Payments and "Cherry Picking" and "Lemon Dropping" in Orthopaedic Surgery? A Systematic Review.

CORR Insights®: Is There an Association Between Bundled Payments and "Cherry Picking" and "Lemon Dropping" in Orthopaedic Surgery? A Systematic Review.

Editorial introductions

Editorial introductions

Age-associated defects in the adaptive immune response to Clostridium difficile infection impair the development of a protective immune response in the elderly

Abstract Clostridium difficile is the number one cause of healthcare-associated infection in the United States and the most lethal acute enteric pathogen. The elderly (≥65) have the greatest risk of C. difficile infection (CDI) and severe morbidity and mortality due to CDI. Additionally, most recurrent CDIs occur within the elderly. To better understand why the elderly are at greater risk of severe and recurrent CDI, our lab has conducted a longitudinal study of the aging immune response to primary and recurrent CDI in patients at Hahnemann University Hospital. Both elderly and young CDI patients were enrolled in the study, and stool and blood samples were collected at enrollment and 12 days after diagnosis of CDI. Analysis of the samples looking at the humoral response in elderly versus young CDI patients shows that the early humoral response in elderly patients is impaired when compared to young CDI patients. In addition, recurrent CDI patients have similarly defective humoral responses. Finally, preliminary work in an aging mouse model of CDI further supports that age-related defects within the adaptive immune response impair the development of a protective immune response. Since the adaptive immune response to CDI plays an important role in neutralizing toxins produced by C. difficile, an impaired humoral response in both aged and recurrent CDI patients may contribute to the increased risk of infection, morbidity, and mortality observed in elderly patients. Future studies will seek to further characterize the aging immune response using patient samples as well as aging mouse models of CDI.

Equity in skin typing: why it is time to replace the Fitzpatrick scale.

Dermatologists of color have long championed skin of color representation in education and workforce diversity. For health equity, we must reconsider even fundamental and accepted terminology. The Fitzpatrick skin type (FST) scale, with both disproportionate focus on white skin tones and inconsistent use, perpetuates skin color bias. Indeed, since FST does not purely objectively estimate skin pigmentation, it may inaccurately assess patients regarding risks for skin cancer and from interventions. Dermatology must seek an objective classification system, and given the rise of artificial intelligence (AI), technology-based approaches may be solutions.