Medical House Staff Research Articles

Understanding the role of antibiotic-associated adverse events in influencing antibiotic decision-making.

To (1) understand the role of antibiotic-associated adverse events (ABX-AEs) on antibiotic decision-making, (2) understand clinician preferences for ABX-AE feedback, and (3) identify ABX-AEs of greatest clinical concern. Focus groups. Academic medical center. Medical and surgical house staff, attending physicians, and advanced practice practitioners. Focus groups were conducted from May 2022 to December 2022. Participants discussed the role of ABX-AEs in antibiotic decision-making and feedback preferences and evaluated the prespecified categorization of ABX-AEs based on degree of clinical concern. Thematic analysis was conducted using inductive coding. Four focus groups were conducted (n = 15). Six themes were identified. (1) ABX-AE risks during initial prescribing influence the antibiotic prescribed rather than the decision of whether to prescribe. (2) The occurrence of an ABX-AE leads to reassessment of the clinical indication for antibiotic therapy. (3) The impact of an ABX-AE on other management decisions is as important as the direct harm of the ABX-AE. (4) ABX-AEs may be overlooked because of limited feedback regarding the occurrence of ABX-AEs. (5) Clinicians are receptive to feedback regarding ABX-AEs but are concerned about it being punitive. (6) Feedback must be curated to prevent clinicians from being overwhelmed with data. Clinicians generally agreed with the prespecified categorizations of ABX-AEs by degree of clinical concern. The themes identified and assessment of ABX-AEs of greatest clinical concern may inform antibiotic stewardship initiatives that incorporate reporting of ABX-AEs as a strategy to reduce unnecessary antibiotic use.

1028: PHARMACOLOGIC INTERVENTIONS ON A SURGICAL INTENSIVE CARE UNIT BY A CLINICAL PHARMACIST

Introduction: Documenting pharmacological interventions in electronic medical record on daily basis can be very time consuming. However, such documentation is extremely important for both quality improvement and cost saving. Methods: A surgical ICU (SICU) clinical pharmacist rounded with the ICU team on the daily basis and documented her pharmacological interventions using Epic ® iVents from January 2021 to June 2022. The SICU had 23 beds, shared by CTICU and Surgical/Trauma ICU. The SICU team included an attending physician (usually a critical care trained trauma surgeon); clinical pharmacist; pharmacy resident; surgical residents; surgical physician assistants; nurses; respiratory therapists; dietitians; and medical school students. Results: The pharmacist documented a total of 3711 ivents in the 18 months. The types of ivents included dosing recommendation (n=1033); initiation of new therapy (n=623); discontinuation of therapy (n= 543); admission medication reconciliation (n=172); recommend lab/test (n=161); therapeutic drug monitoring/kinetics (n=158); iv to po medication switch (n=127); develop medication weaning plans (n=104); duration of therapy (n=81); renew expired medication (n=76); order clarification (n=68); route or formulation change (n=62); restart medication (n=53); antimicrobial de-escalation (n=47); hold medication (n=44); adverse drug event (n=37); high cost drug medication review (n=32); antimicrobial escalation (n=30); restart home medication (n=26); medication rate change (n=22); vancomycin AUC calculation (n=22); clinical drug information (n=17); non-formulation to formulation medication (n=17); VTE prophylaxis initiation (n=17); height and weight verification (n=10); stress ulcer prophylaxis initiation (n=17); drug interaction (n=10); administration time change (n=17); antimicrobial drug-bug mismatch (n=16); restricted medication approval (n=27); and others. Conclusions: The surgical ICU clinical pharmacist was able to document an average of 206 medication interventions in Epic ® per month (ranges: 138 to 296). The highest number of ivents documented occurred in July when new medical house staff started the training. Documenting pharmacist interventions is critical for quality improvement; patient care outcome; and justification for more pharmacist personnel.

Prevalence of Depression and Anxiety Among Medical Students and House Staff During the COVID-19 Health-Care Crisis.

ObjectiveThe objective of the study was to evaluate the prevalence of anxiety and depression among medical trainees during the initial wave of the COVID-19 pandemic.MethodsThis was a cross-sectional study of the prevalence of depression and anxiety among medical students, residents, and fellows at a medical university hospital in New York using self-reported PHQ-9 and GAD-7 screening tools administered via an anonymized survey. The study was conducted in April 2020.ResultsThe authors received 438 responses (33.4% response rate). Nearly half (44.5%) were medical students and female (56.6%). The prevalence of positive screen for depression (45.3%) and anxiety (48.1%) was high. Many reported moderate to severe depression (17.2%) and anxiety (20.3%). Over half (57.3%) experienced significant mood changes and inability to concentrate, and 14.6% had reconsidered their choice of profession since the start of the pandemic. Those who had reconsidered their profession had higher PHQ-9 [8.1 (6.4) vs 4.4 (4.3), p < 0.0001] and GAD-7 scores [8.3 (6.1) vs 4.7 (4.6), p < 0.0001], indicating adverse mental health partly contributed to their reconsideration of choice of profession. Women were more likely to screen positive for anxiety (OR: 1.68) and medical students more likely to screen positive for anxiety (OR: 2.55) and depression (OR: 2.74).ConclusionThe COVID-19 pandemic has placed great strain on health-care resources, including the mental health of medical trainees.

A Novel Model for a Student-Led Surgical Anatomy Seminar

We describe a novel educational model for a student-led anatomy interest group that utilizes an efficient method of knowledge sharing among peers in order to supplement the standard gross anatomy curriculum and expose medical students to advanced, surgically relevant anatomy. Student leaders of the Advanced Anatomy Interest Group compile a list of advanced anatomy "tidbits" related to a topic within a particular surgical specialty. Each medical student participant signs up for a different "tidbit" and prepares a short presentation. On meeting day, students present to the group. After each presentation, a surgical faculty moderator offers feedback and provides additional surgical perspective. Duke University School of Medicine, Durham, NC, USA. Three third year medical student interest group leaders, 20 first through fourth year medical student participants, and 1 surgical faculty moderator. Twelve students presented an advanced anatomy tidbit, and 15 students responded to a 10-question postmeeting survey. Over 90% of respondents either agreed or strongly agreed that their understanding of surgically relevant anatomy had improved. Of those students who presented, 100% agreed or strongly agreed that their preparedness to briefly teach complex medical topics to colleagues had improved. Additionally, students reported increased interest in surgery and an improved perception of surgeons. This novel educational model appears to be an effective and efficient way to supplement the standard gross anatomy curriculum and expose medical students to advanced, surgically relevant anatomy. In addition, this model enables students to hone their presentation skills, gain experience teaching advanced medical concepts to peers, and develop relationships with surgical faculty. Surgical faculty are also not burdened with any preparatory responsibilities, making their participation more feasible. This model can serve as a template for medical students, house staff, and faculty interested in expanding anatomy education at their own institutions.

COVID-19 pandemic through the lens of a gastroenterology fellow: looking for the silver lining

COVID-19 pandemic through the lens of a gastroenterology fellow: looking for the silver lining

Radiation Therapy in King County, Washington During the COVID-19 Pandemic: Balancing Patient Care, Transmission Mitigation, and Resident Training

Radiation Therapy in King County, Washington During the COVID-19 Pandemic: Balancing Patient Care, Transmission Mitigation, and Resident Training

Gender differences among medical students, house staff, and faculty physicians at high risk for suicide: A HEAR report.

In comparison with the general population, physicians, and physicians-in-training are at greater risk for suicide. Although key gender differences in suicide risk factors and behaviors have been identified in the general population, the extent to which these differences apply to physicians and physicians-in-training is unclear. Here, we aimed to identify gender differences in risk factors, clinical presentation, and help-seeking behaviors of medical students, house staff, and physician faculty at high risk for suicide. We explored gender differences among 450 physicians and trainees meeting criteria for high suicide risk on anonymous online questionnaires completed between 2009 and 2017. High-risk female trainees and physicians had higher mean Patient Health Questionnaire-9 (PHQ-9) scores compared with the males (11.1, standard deviation [SD] 5.1 vs. 9.8, SD 4.7) and were more likely to endorse feeling worried (73.8% vs. 61.2%), irritable (60.4% vs. 49.4%), and stressed (79.6% vs. 70%). High-risk male trainees and physicians were more likely than females to endorse suicidal thoughts (31.2% vs. 22.1%), intense anger (24.3% vs. 16.1%), drinking too much (31.2% vs. 22.3%), and recreational drug or prescription medication use without clinically appropriate follow-up (9.4% vs. 4.3%). There were no gender differences in help-seeking behaviors. This is the first study to report gender differences among risk factors, presentation, and help-seeking behaviors of physicians, and trainees at high risk for suicide. Our findings are mostly consistent with those of the general population and show that only a minority of at-risk men and women in healthcare sought treatment, highlighting the importance of intervention and suicide prevention in this population.

Teamwork Among Medicine House Staff During Work Rounds: Development of a Direct Observation Tool.

Teamwork is integral to effective health care but difficult to evaluate. Few tools have been tested outside of classroom or medical simulation settings. Accordingly, we aimed to develop and pilot test an easy-to-use direct observation instrument for measuring teamwork among medical house staff. We performed direct observations of 18 inpatient medicine house staff teams at a teaching hospital using an instrument constructed from existing teamwork tools, expert panel review, and pilot testing. We examined differences across teams using the Kruskal-Wallis statistic. We examined interrater reliability with the κ statistic, domain scales using Cronbach α, and construct validity using correlation and multivariable regression analyses of quality and utilization metrics. Observers rated team performance before and after providing feedback to 12 of the 18 team leaders and assessed changes in team performance using paired two-tailed t tests. We found variation in team performance in the situation monitoring, mutual support, and communication domains. The instrument evidenced good interrater reliability among concurrent, independent observers (κ = 0.7, P < 0.001). It had satisfactory face validity based on expert panel review and the assessments of resident team leaders. Construct validity was supported by a positive correlation between team performance and the Hospital Consumer Assessment of Healthcare Providers and Systems physician communication score (r = 0.6, P = 0.03). Providing resident physicians with information about their teams' performance was associated with improved mean performance in follow-up observations (3.6-3.8/4.0, P = 0.001). Direct observation of teamwork behaviors by medicine house staff on ward rounds is feasible and feedback may improve performance.

Writing to learn on the wards: scholarly blog posts by medical students and housestaff at a teaching hospital

ABSTRACTBackground: Informative writing is a valuable tool for learning and fostering the scientific process. Pearls4Peers (P4P) is an educational open-access website dedicated to scholarly blog posts in hospital medicine based on questions raised during ward teaching rounds. A goal of P4P is to enhance the learning experience of medical students and housestaff (i.e., interns and upper-level residents) by inviting them to write blog posts for a worldwide audience.Objective: To describe our experience with inviting medical students and housestaff to contribute blog posts to a clinically oriented educational website with the aim of promoting concise evidence-based informative medical writing.Design: Medical students and housestaff assigned to the hospital ward team of an attending physician (FM) on the medical service were routinely invited to submit one or more posts or ‘pearls’ based on clinical questions raised during patient rounds. Selected features of submissions during the first 2 years of P4P (27 June 2015 through 26 June 2017) were then retrospectively reviewed and analyzed.Results: Of 156 pearls posted during the study period, 25 (16%) were contributed by medical students and 16 (10.3%) by housestaff. Medical students were significantly more likely to contribute than housestaff (19[70.4%] vs. 11 (9.6%], p < 0.01). Superfluous information was noted in 12 (29.3%) submissions. Word count exceeded the suggested limit of 200 words in 12 (29.3%) cases. An inverted pyramid structure, a widely recognized web writing format with the most important information presented at the outset, was noted in only 17 (41.5%) of entries. Unsolicited comments by contributors suggested a positive learning experience in writing the posts.Conclusions: Writing clinically oriented concise blog posts appears feasible and may be an effective tool in enhancing the ward-based learning experience of medical students and housestaff. More formal instructions on the proper content and structure of blog posts seem warranted.

Measuring Medical Housestaff Teamwork Performance Using Multiple Direct Observation Instruments: Comparing Apples and Apples.

To examine the composition and concordance of existing instruments used to assess medical teams' performance. A trained observer joined 20 internal medicine housestaff teams for morning work rounds at Tufts Medical Center, a 415-bed Boston teaching hospital, from October through December 2015. The observer rated each team's performance using nine teamwork observation instruments that examined domains including team structure, leadership, situation monitoring, mutual support, and communication. Observations recorded on paper forms were stored electronically. Scores were normalized from 1 (low) to 5 (high) to account for different rating scales. Overall mean scores were calculated and graphed; weighted scores adjusted for the number of items in each teamwork domain. Teamwork scores were analyzed using t tests, pairwise correlations, and the Kruskal-Wallis statistic, and team performance was compared across instruments by domain. The nine tools incorporated five major domains, with 5 to 35 items per instrument, for a total of 161 items per observation session. In weighted and unweighted analyses, the overall teamwork performance score for a given team on a given day varied by instrument. While all of the tools identified the same low outlier, high performers on some instruments were low performers on others. Inconsistent scores for a given team across instruments persisted in domain-level analyses. There was substantial variation in the rating of individual teams assessed concurrently by a single observer using multiple instruments. Because existing teamwork observation tools do not yield concordant assessments, researchers should create better tools for measuring teamwork performance.

Mental Health During Residency Training: Assessing the Barriers to Seeking Care.

Resident and fellow physicians are at elevated risk for developing depression compared to the general population; however, they are also less likely to utilize mental health services. We sought to identify the barriers to seeking mental health treatment among residents across all specialties at a large academic medical center in Chicago, IL. Residents and fellows from all programs were asked to complete an anonymous self-report questionnaire. Of the 18% of residents and fellows that completed the survey, 61% felt they would have benefited from psychiatric services. Only 24% of those who felt they needed care actually sought treatment. The most commonly reported barriers to seeking care were lack of time (77%), concerns about confidentiality (67%), concerns about what others would think (58%), cost (56%), and concern for effect on one's ability to obtain licensure (50%). Despite feeling that they require mental health services, few trainees actually sought care. This study identifies an overall need for improved access to mental health providers and psychoeducation for medical housestaff.

Encouraging Mindfulness in Medical House Staff via Smartphone App: A Pilot Study.

Stress and burnout are increasingly recognized as urgent issues among resident physicians, especially given the concerning implications of burnout on physician well-being and patient care outcomes. The authors assessed how a mindfulness and meditation practice among residents, supported via a self-guided, smartphone-based mindfulness app, affects wellness as measured by prevalidated surveys. Residents in the departments of general surgery, anesthesia, and obstetrics and gynecology were recruited for participation in this survey-based, four-week, single-arm study. All participants used the app (Headspace) on a self-guided basis, and took surveys at enrollment, at 2 weeks, and at 4 weeks. The Positive and Negative Affect Schedule (PANAS) assessed mood, and the Freiburg Mindfulness Inventory (FMI) measured mindfulness. Forty-three residents enrolled in this study from April 2015 to August 2016; 30 residents (90% female) completed two or more surveys, and so were included for further analysis. In a comparison of baseline scores to week four scores, there was a significant increase in FMI at week four (36.88±7.00; Cohen's d=0.77, p=0.005), a trend toward increase in the positive affect score (PAS) (31.73±6.07; Cohen's d=0.38, p= 0.08), and no change in negative affect score (NAS) (21.62±7.85; Cohen's d=-0.15, p=NS). In mixed-effect multivariate modeling, both the PAS and the FMI scores showed significant positive change with increasing use of the smartphone app (PAS, 0.31 (95% CI 0.03-0.57); FMI, 0.38 (95% CI 0.11-0.66)), while the NAS did not show significant change. Study limitations include self-guided app usage, a homogenous study subject population, insufficient study subjects to perform stratified analysis of the impact of specialty on the findings, lack of control group, and possible influence from the Hawthorne effect. This study suggests the feasibility and efficacy of a short mindfulness intervention delivered by a smartphone app to improve mindfulness and associated resident physician wellness parameters.

Increasing awareness of age-related fertility and elective fertility preservation among medical students and house staff: a pre- and post-intervention analysis

To assess medical students' and house staff's knowledge and personal and professional perceptions of age-related fertility and fertility preservation before and after an educational intervention. Pre-/post intervention survey. University-based medical center. Medical students and house staff. An educational session on age-related fertility decline and elective fertility preservation. Knowledge scores and perceptions assessed immediately before and after the intervention. Sixty-five surveys were administered. Of the 53 respondents, 71.7% were married or in a committed relationship; 89.4% reported that they were delaying childbearing, with career and/or education being the most frequently listed reason (85.7%); 39.5% indicated that they had both personal and professional interest in fertility preservation but identified finances (62.5%) and time (59.4%) as barriers; 86.9% indicated previous exposure, with formal education (80.0%) and social media (40.0%) being the most common sources. Mean scores on a six-question knowledge-based assessment improved significantly following the presentation (54.6 ± 19.0% vs. 78.1 ± 16.0%), as did the number of participants who indicated that they might now recommend elective oocyte cryopreservation to others (71.1% vs. 54.3%). After the intervention, 97.8% thought that it was important for medical professionals to be informed about age-related fertility decline and elective oocyte cryopreservation. Despite professional and personal interest, knowledge of age-related fertility decline and elective fertility preservation is limited among medical students and house staff. This study highlights the need for formal education across all levels of training and specialties, with even brief interventions being of potential benefit.

Becoming Reconciled to MedRec

Becoming Reconciled to MedRec

Impact of Glucose Management Team on Outcomes of Hospitalization in Patients With Type 2 Diabetes Admitted to the Medical Service

To improve glycemic control of hospitalized patients with diabetes and hyperglycemia, many medical centers have established dedicated glucose management teams (GMTs). However, the impact of these specialized teams on clinical outcomes has not been evaluated. We conducted a retrospective study of 440 patients with type 2 diabetes admitted to the medical service for cardiac or infection-related diagnosis. The primary endpoint was a composite outcome of several well-recognized markers of morbidity, consisting of: death during hospitalization, transfer to intensive care unit, initiation of enteral or parenteral nutrition, line infection, new in-hospital infection or infection lasting more than 20 days of hospitalization, deep venous thrombosis or pulmonary embolism, rise in plasma creatinine, and hospital re-admissions. Medical housestaff managed the glycemia in 79% of patients (usual care group), while the GMT managed the glycemia in 21% of patients (GMT group). The primary outcome was similar between cohorts (0.95 events per patient versus 0.99 events per patient in the GMT and usual care cohorts, respectively). For subanalysis, the subjects in both groups were stratified into those with average glycemia of <180 mg/dL versus those with glycemia >180 mg/dL. We found a significant beneficial impact of glycemic management by the GMT on the composite outcome in patients with average glycemia >180 mg/dL during their hospital stay. The number of patients who met primary outcome was significantly higher in the usual care group (40 of 83 patients, 48%) than in the GMT-treated cohort (8 of 33 patients, 25.7%) (P<.02). Our data suggest that GMTs may have an important role in managing difficult-to-control hyperglycemia in the inpatient setting. BG = blood glucose GMT = glucose management team HbA1c = hemoglobin A1c ICU = intensive care unit POC = point of care T2D = type 2 diabetes.

Impact of a Multidisciplinary Team Approach Including an Intensivist on the Outcomes of Critically Ill Patients in the Cardiac Care Unit

ObjectiveTo investigate the impact of integrating a medical intensivist into a cardiac care unit (CCU) multidisciplinary team on the outcomes of CCU patients. Patients and MethodsWe conducted a retrospective cohort study of 2239 CCU admissions between July 1, 2011, and July 1, 2013, which constituted patients admitted in the 12 months before and 12 months after the introduction of intensivists into the CCU multidisciplinary team. This team included a cardiologist, a medical intensivist, medical house staff, nurses, a pharmacist, a dietitian, and physical and respiratory therapists. The primary outcome was CCU mortality. Secondary outcomes included hospital mortality, CCU length of stay, hospital length of stay, and duration of mechanical ventilation. ResultsAfter the implementation of a multidisciplinary team approach, there was a significant decrease in both adjusted CCU mortality (3.5% vs 5.9%; P=.01) and hospital mortality (4.4% vs 11.1%; P<.01). A similar impact was observed on adjusted mean CCU length of stay (2.5±2.0 vs 2.9±2.0 days; P<.01), adjusted mean hospital length of stay (7.0±4.5 vs 7.5±4.5 days; P<.01), and adjusted mean ventilation duration (2.0±1.0 vs 4.3±2.5 days; P<.01). ConclusionThe implementation of a multidisciplinary team approach in which an intensivist and a cardiologist comanage the critical care of CCU patients is feasible and may result in better patient outcomes.

A Multidisciplinary Housestaff-Led Initiative to Safely Reduce Daily Laboratory Testing.

Provision of high-value care is a milestone in physician training. The authors evaluated the effect of a housestaff-led initiative on laboratory testing rates. Vanderbilt University Medical Center's Choosing Wisely steering committee, led by housestaff with faculty advisors, sought to reduce unnecessary daily basic metabolic panel (BMP) and complete blood count (CBC) testing on inpatient general medicine and surgical services. Intervention services received a didactic session followed by regular data feedback with goal rates and peer comparison. Testing rates during January 1, 2013-February 9, 2015, were compared on intervention services and control services using a difference-in-differences analysis and an interrupted time-series analysis with segmented linear regression. Compared with concurrent controls, the mean number of BMP tests per patient day decreased by an additional 0.23 (95% CI 0.17-0.29) on medical housestaff and 0.15 (95% CI 0.09-0.21) on hospitalist intervention services. Daily CBC tests decreased by an additional 0.28 (95% CI 0.23-0.33) on medical housestaff, 0.08 (95% CI 0.03-0.13) on hospitalist, and 0.12 (95% CI 0.05-0.20) on surgical housestaff intervention services. Patients with lab-free days (0 labs ordered in 24 hours) increased by an additional 4.1 percentage points (95% CI 2.1-6.1) on medical housestaff and 9.7 percentage points (95% CI 6.6-12.8) on hospitalist intervention services. There were no adverse changes in length of stay or intensive care unit transfer, in-hospital mortality, or 30-day readmission rates. A housestaff-led intervention utilizing education and data feedback with goal setting and peer comparison resulted in safe, significant reductions in daily laboratory testing rates.

Arnold M. Katz: 1932-2016.

Cardiology lost a luminary on January 25, 2016. Arnold M. Katz died after a 14-year battle with non-Hodgkin lymphoma. At the time of his death, he was honorary professor of medicine and physiology at the Geisel School of Medicine at Dartmouth. Arnie was the justifiably proud son of a remarkable father, Louis N. Katz, an early president of the American Heart Association. Arnie attended the University of Chicago as an undergraduate and received his medical degree cum laude from Harvard Medical School in 1956. During summers, he worked in his father’s laboratory at Michael Reece Hospital on coronary blood flow and left ventricular volume, leading to first-authored papers in the American Journal of Physiology and Circulation Research before he finished medical school. After a year of medical internship at the Massachusetts General Hospital, Arnie served as a research associate in the laboratory of future Nobel Laureate Christian Anfinsen at the National Institutes of Health. A resulting 1959 publication on peptide separation in the Journal of Biological Chemistry remains frequently cited >50 years later.1 Arnie resumed his clinical training as a medical resident at the Massachusetts General Hospital and assistant registrar at the National Heart Hospital in London with Dr Paul Wood. This was followed by a research fellowship at UCLA with Wilfred Mommaerts. As an American Heart Association Established Investigator, Arnie was first appointed to the medical faculty at Columbia University and then the University of Chicago. In 1969, he became the first Philip J. and Harriet L. Goodhart Professor of Medicine (Cardiology) at Mount Sinai School …

Housestaff perspectives on end-of-life training during medical school and residency.

27 Background: Participating in end-of-life discussions and delivering bad news is integral to oncology practice. Poor communication skills can negatively impact a patient’s understanding and acceptance of their disease process, increase their anxiety, and lead to anger and depression. Hematology/Oncology fellowship training (HOFT) programs may assume incoming fellows are capable of doing this well. A study by Hebert et al. revealed 37% of HOFT programs provide little to no formal training in this area. Our study sought to assess housestaff preparedness and comfort with end-of-life (EOL) discussions. Methods: An email survey was sent to 787 residents and fellows at a single institution in February 2015. Housestaff were queried as to extent of training, experience, supervision and comfort with EOL communication in both medical school and residency. Results: 176 surveys (22.4 %) were returned.During Medical School: Many housestaff (55.1%) reported “little” to “no” classroom training on EOL discussions. Most, 85.1%, reported having five or fewer EOL discussions. Most encounters (78.6%) were supervised by an attending or resident. Only 45.5% felt “somewhat” to “fully prepared” to have EOL discussions when graduating medical school. During Residency: Housestaff reported even less classroom training on EOL discussions: 88.2% reported “little” to “no training”. EOL discussions were more common: 51% reported more than 10 EOL conversations with patients. The level of supervision decreased: only 38.6% reported encounters were mostly supervised. Most housestaff (75%) feel comfortable with having EOL discussions at their current level of training. Conclusions: Despite increased awareness regarding the importance of EOL discussion education, it remains an area that a significant number of medical students and housestaff receive little to no training. EOL discussions by housestaff are frequently unsupervised, reducing opportunities for improvement via feedback. Competence in delivering bad news is an important skill for hematologists/oncologists. Our findings support the previously published perception of HOFT program directors that additional training and resources in delivering bad news is needed.

The Role of an Integrated Multidisciplinary Clinic in the Management of Patients with Cutaneous Lymphoma.

The clinical benefit of a multidisciplinary clinic practice model has been well described in a variety of medical specialties and cancer types. It proves particularly valuable when an integrated team is needed to optimally manage patients with rare or complex neoplasms. However, the ideal implementation of an integrated multidisciplinary care program for translational research and education has not been well reported. Herein, we propose how a multimodality cutaneous lymphoma (CL) clinic model can optimally manage CL patients. We offer our perspective on this model as an efficient means for delivering patient care, a continuing education resource for referring physicians, a conduit for translational and clinical research, and an educational tool for medical students, house staff, and fellows.