Medical Scholars Program Research Articles

Cleft Palate Surgery

INTRODUCTION: Cleft palate repair is a widely performed pediatric surgery yet rates of common peri-operative morbidities remain unclear. This study examines a national sample of patients to assess peri-operative outcomes for cleft palate repair as well as hospital factors impacting quality and patient safety. Specifically, this study evaluates whether pediatric hospitals use fewer resources and potentially provide better quality care. METHODS: Data were obtained from the Kids Inpatient Database from 1997, 2000, 2003, and 2006. Cohort was identified using the ICD-9-CM procedure code for cleft palate surgery (27.62). We examined patient age, race, sex, insurer, and comorbidities. Hospitals types included Pediatric Hospitals, General Hospitals, and Non-accredited Children's Hospital (NAPH). Quality measures were mean length of stay (LOS), extended mean LOS (LOS>2), and complications. Quality measures were assessed by age groups <9 months, 9-12 months, >12 months. RESULTS: 14,153 patients had cleft palate repair with mean LOS of 2 days (SD 0.04), mortality rate of 0.01%, and transfusion rate of 0.3%. Less than 3% of children experienced a complication during their hospital stay. Complication rates did not vary with age but quadrupled in those with LOS>2 days. Comorbidities increased odds of LOS>2 by 2.7 times; comorbidities were highest in Pediatric Hospitals yet those cared for in non-pediatric hospitals had 4.3 times higher odds of LOS>2. Median total charges was $10,835 and increased to $15,104 with LOS>2; median total costs was $4,367, but increased to $6,148 with LOS>2. CONCLUSION: Cleft palate surgery has low mortality and acute complications. Pediatric Hospitals had higher comorbidities yet shorter LOS and fewer patients with LOS>2 than General Hospitals and NAPH. Total charges and costs nearly doubled with LOS>2. Additional research is needed to understand pediatric hospital resources associated with lower LOS, and thereby lower costs. DISCLOSURES: This study was supported in part by the Medical Scholars Program from Stanford University School of Medicine, grant number TLI RR025742 from Stanford NIH/NCCR CTSA, VA RR&D Career Development Award (to Catherine Curtin, MD), and grant number K01HS018558 from the Agency for Healthcare Research and Quality. The content is solely the responsibility of the authors and does not necessarily represent the official views of the Department of Veterans Affairs, Stanford University or the Agency for Healthcare Research and Quality.

158. Development and Testing of the Readiness for Adult Care in Rheumatology (RACER) Questionnaire for Adolescents With Rheumatic Conditions

older age. Conclusions: Youth with CP receive significantly less transition guidance from health care providers than youth with other SHCN. While policies and practices to increase transition guidance for all youth with SHCN would help youth with CP, special approaches to transition guidance are needed for this group of youth. Sourcesof Support:Katie Jacksonwas supportedfinancially by the Vanderbilt Medical Scholars Program; however, the supporter was not involved in the study design, data collection, data analysis, manuscript preparation, or publication decisions.

Alcohol Medical Scholars Program—A Mentorship Program for Improving Medical Education Regarding Substance Use Disorders

ABSTRACT The Alcohol Medical Scholars Program (AMSP) is designed to improve medical education related to substance use disorders (SUDs) through mentorship of junior, full-time academic faculty from medical schools across the United States. Scholarship focuses on literature review and synthesis, lecture development and delivery, increasing SUD education in their medical schools, professional development, and networking. Results are reported from an anonymous survey of self-reported changes in educational involvement by 28 of 33 AMSP graduates. Participation was associated with a 4-fold increase in yearly SUD lecture time and topics, increased numbers of medical disciplines taught and trained in clinical rotations, design of new SUD-related electives and journal clubs, and membership on medical education committees. Sixty percent of scholars reported promotion since involvement in AMSP, with the majority endorsing the organization's contribution to professional development. AMSP is a useful mentorship model for junior faculty and is associated with increasing SUD-related medical education.

Admission Factors Predicting Family Medicine Specialty Choice: A Literature Review and Exploratory Study Among Students in the Rural Medical Scholars Program

The Rural Medical Scholars Program (RMSP) was created to increase production of rural family physicians in Alabama. Literature review reveals reasons medical students choose careers in family medicine, and these reasons can be categorized into domains that medical schools can address through admission, curriculum, and structural interventions. We examine whether admission factors can predict family medicine specialty choice among students recruited from rural Alabama. We developed a questionnaire to study the ability of admission factors to predict family medicine specialty choice among Rural Medical Scholars (RMS). Eighty RMS graduates were surveyed by mail and 64 (80%) responded. Student characteristics of humanitarian outlook with commitment to rural or underserved populations, family medicine decision or intention made before or at medical school admission, and community influence were positive associations with RMS choosing family medicine residencies; shadowing in an urban hospital was a negative association. Statements of interest, intentions, plans, and decisions regarding family medicine should be elicited at the time of RMSP admission interview. Strong attachment to home community and commitment to serving and living in a rural area are also important. Students whose introduction to medicine was informed through shadowing or observing in urban hospitals should be considered less likely to become family physicians. Larger sample size studies are needed to assess the role of gender, race, marital status, size of rural town, and MCAT score of candidates in affecting residency choices of students selected for this rural medical education track.

The Rural Medical Scholars Program Study: Data to Inform Rural Health Policy

medical education to produce rural physicians hinges on the characteristics of students, educational programs, and rural experiences. Family physicians are key components of rural medicine. This study tested the effectiveness of multiple, combined strategies of the Rural Medical Scholars Program to produce family medicine residents. we compared the relative effectiveness of the Rural Medical Scholars Program, family medicine-oriented branch campuses, and a traditional urban campus to produce family medicine residents using a prospective quasi-experimental design. Logistic regression was used to account for covariates. the relative effectiveness of 3 educational modalities to produce family medicine residents was examined: Rural Medical Scholars Program (44.0%; odds ratio [OR], 15.6), family medicine-oriented branch campuses (18.9%; OR, 5.8), and a traditional urban campus (3.9%; OR, 1). These differences were significant (P < .05) after controlling for sex, race, Medical College Admission Test scores, and graduation rate. the findings are consistent with the literature, which recommends multiple strategy interventions to produce rural physicians (e.g., admit rural students who have an interest in family medicine, use family medicine faculty, and provide rural experiences). Further study will determine whether rural practice follows training in family medicine among Rural Medical Scholars.

State University of New York Upstate Medical University College of Medicine

State University of New York Upstate Medical University College of Medicine

University of Alabama School of Medicine

University of Alabama School of Medicine

Rural Health Leaders Pipeline, 1990–2005: Case Study of a Second-Generation Rural Medical Education Program

ABSTRACT A pipeline model has been suggested to increase the rural physician supply. This study is an institutional case report used to describe the context, development, and in-house evaluation of the University of Alabama Rural Health Leaders Pipeline, 1990–2005. This program was developed at a University of Alabama School of Medicine branch campus to target rural students at multiple levels, elementary schools through residency, and includes a minority focus. Requirements to enter the medical program include living 8 years in rural Alabama, meeting admission requirements, and affinity for rural lifestyles. Twenty-six percent of 316 high school participants, all 40 students in the minority-focused college program, and 3% of 90 medical program students were African American. The program includes (1) puppet shows in elementary schools depicting different health professions, (2) Rural Health Scholars Program for 11th-grade students, (3) Minority Rural Health Pipeline Program for college students, (4) Rural Medical Scholars Program, a 5-year track of study in rural community health and medicine, and (5) assured admission to family medicine residency. Outcomes studied in this case report included medical school performance, graduation rate, selection of family medicine specialty, and rural practice location. Medical scholars were anticipated to experience academic difficulty, select family medicine specialty, and locate in rural practice more often than peers. Compared to peers, medical scholars showed lower scores on preclinical courses and USMLE steps 1 and 2, reflective of their lower MCAT and GPA scores, but had (1) similar graduation rates (95% vs peers 84%), (2) higher family medicine selection rate (47% vs Huntsville 27% vs Tuscaloosa 12% vs Birmingham 4% [OR compared to Birmingham 22.7, 95% CI 10.5–49.4]), and (3) higher rural practice rate (67% vs peers 14% vs national group 9%) in the first RMSP classes. Based on these important outcomes being better than or equal to the traditional student cohorts, the institution concluded that the Rural Health Leaders Pipeline demonstrates successful use of the rural pipeline model.

Creating a Teacher‐Scholar Training Program for Anatomy at the University of Utah School of Medicine

Developing doctoral programs to train the next generation of anatomy teacher‐scholars will be essential to respond to the manpower shortage of medical gross anatomy, histology, embryology, and neuroanatomy teachers that is anticipated by 2010. At the program level, rigor is required to meet the expectations of traditional doctoral training programs, such as education in theoretical and practical disciplines. Our program provides training in educational research theory because advancement in academic medicine is dependent on research scholarship. That training goal is complimented by education in ethics of research, institutional review board (IRB) protocols, scientific writing, and biostatistics. Other courses, such as scientific lecturing, journal club, and research‐in‐progress, provide practical experience in presenting research. An IRB‐approved, educational research project is required, for which the results are to be submitted as a first‐authored, peer‐reviewed manuscript. Another requirement is innovation of teaching tools, such as paper or electronic textbooks, dissection guides, or educational software. Trainees also take and teach medical gross anatomy, histology, embryology, and neuroscience. At the institutional level, recognition of and reward for teacher‐scholar contributions and accomplishments is required. Our institution, like other institutions, has created as faculty track for teacher‐scholars, which reflects the growing change in attitude about the value of teaching in medical schools. Further programmatic growth requires curriculum integration with the College of Education, and establishment of endowed funding for trainee stipends. [Support from Dept of Neurobiol &amp; Anat and Medical Scholars Program]

Graduate Students' Perceptions of Outstanding Graduate Advisor Characteristics

The advising literature confirms the graduate student–graduate advisor relationship as the most important factor in graduate student success. To better understand the characteristics of graduate advisors that students find most helpful, we conducted a grounded theory study with a constructivist design that involved a qualitative textual analysis of Outstanding Graduate Advisor of the Year Award nominations from MD-PhD students enrolled in the Medical Scholars Program at the University of Illinois at Urbana-Champaign. Five major themes emerged from this analysis, and the results indicate that students perceive the following graduate-advisor characteristics to be most helpful: demonstrated care for students, accessibility, role models in professional and personal matters, individually tailored guidance, and proactive integration of students into the profession.Relative Emphasis: research, practice, theory

Cadaver‐based case studies increase the value and utility of cadaver dissection in medical education.

In 2003, we launched a teaching innovation, the “cadaver autopsy,” for the purpose of integrating the gross anatomy, histology, and pathology courses for first-year medical students. The initial impact of the cadaver autopsy project was greater interaction among students, anatomy faculty, and pathology faculty within one course. Greater impacts have been enhanced recognition of the value and utility of cadaver dissection and use of microscopes for teaching anatomy and pathology. The greater impacts came about by developing case studies around the cadaver autopsies, about which the students wrote 2-page essays. The case studies were developed while students dissected cadavers in gross anatomy, during which we photographed anatomy and pathology, and subsequently added photographs of the corresponding histology and histopathology of the excised tissue specimens. We used the photographs and student autopsy essays to create case studies for presentation in the first-year pathology course. Case studies included cerebral stroke, metastatic lung cancer, myocardial infarction, subdural hematoma with associated uncal herniation, and a systemic view of the consequences of obesity. We conclude that cadaver-based studies expand educational opportunities and the value of cadaver dissection. [Supported by Departments of Neurobiology & Anatomy and Pathology, and the Medical Scholars Program at the UofU]

Creativity.com: Aladdin’s Cave or Pandora’s Box?

Today, creativity has moved beyond its traditional home in the rhetoric of the philosopher and the exploits of the artist to form an integral part of both the theory and practice of a myriad of disciplines. Health professionals (Dossey; Kirklin & Meakin; Meites, Bein & Shafer; Rees; Satalof), scientists (Bohn 1-3, 13-15; Culross), educators (Guilford; Sawyer; Sternberg & Williams; Wilks) and those involved in the corporate world (Forbes & Domm; Mauzy & Harriman; Robinson & Stern) all consider creativity to be a fundamental criterion by which they measure and achieve their successes. 2 In this way, however, creativity has become something of an over-burdened signifier. Now the market is flooded with highly idealised and ever expanding models for understanding and transmitting creativity, in which the medium (transmission) strives to outdo the message (creativity itself). We are not attempting here to arbitrate between these various models with a view to providing a rank order of creativity. Instead, we want to focus on and explore the ways in which recent technological developments, primarily the internet, have been, and might be, used to transmit and facilitate new directions and expressions of creativity and the creative process itself. 3

Stanford University School of Medicine, Arts and Humanities Medical Scholars Program.

Stanford University School of Medicine, Arts and Humanities Medical Scholars Program.

Engaging Science: How to Understand Its Practices Philosophically (review)

Reviewed by: Engaging Science: How to Understand Its Practices Philosophically * Paul T. Durbin (bio) Engaging Science: How to Understand Its Practices Philosophically. By Joseph Rouse. Ithaca, N.Y.: Cornell University Press, 1996. Pp. ix+282; notes, bibliography, index. $39.95 (cloth); $16.95 (paper). In the past decade or so, Joseph Rouse has become one of the most prolific and controversial philosophers within the philosophy of science community of the United States. Engaging Science is a masterly summary and exposition of his contributions and critiques of others’ contributions to the field. It is also his best presentation to date of the perspective he espouses, which he calls “cultural studies of science.” Rouse is a careful and cautious writer. Although it can be a challenge to follow the nuances of his argumentation, he can also be quite clear about the points he wishes to make. He begins this book with a summary statement of what he opposes: “For all their complexity and internal differentiation, [the] traditions [of postpositive philosophy of science] have important common themes and fundamental shared issues that mark the disputes among them” (p. 1). In a long footnote appended to this claim, Rouse lists the many authors whose work he discusses: the “inaugurators” of postpositivism, N. R. Hanson, Thomas Kuhn, Stephen Toulmin, Paul Feyerabend, and Michael Polanyi; its “developers,” Imre Lakatos, Dudley [End Page 546] Shapere, Mary Hesse, and Larry Laudan; authors whom Rouse likes but who retain “positivist affinities,” such as Arthur Fine, Nancy Cartwright, and Ian Hacking; “realists” Wilfrid Sellars, J. J. C. Smart, Grover Maxwell, Hilary Putnam, and Richard Boyd; their “antirealist” opponents Bas van Fraassen and Clark Glymour; and—here Rouse names no individual authors—“the social constructivist tradition [that] begins with the Edinburgh Strong Programme but has been substantially modified by . . . Bath relativism, ethnographic studies, discourse analysis, actor/network theory, and constitutive reflexivity” (pp. 1–2, n. 1). In short, Rouse takes on almost all the main contributors to contemporary philosophy and sociology of science—and treats them all fairly and in detail. Rouse is equally clear at the end of the book, where social constructivism as represented by Harry Collins and Steven Yearley is compared with “cultural studies” as represented best (Rouse thinks) by Donna Haraway. This is Rouse’s final paragraph: To put the difference polemically, social constructivism is antagonistic to the cultural authority claimed by the natural sciences but uncritical of scientific practices. Cultural studies reverse this stance, aiming to participate in constructing reliable and authoritative knowledge of the world by critically engaging with the sciences’ practices of making meanings. (p. 259) It is, Rouse says, with this freedom-enhancing, life-improving critical enhancement of science that he wishes to be identified, rather than with attacks on, or defenses of, the authority of science as it is currently practiced. Historians of technology impatient with finely detailed philosophical distinctions and arguments will find Rouse’s book difficult. But those willing to do the intellectual hard labor will be rewarded with a virtually encyclopedic summary of (Rouse’s slant on) recent discussions in philosophy of science—even if they end up finding Rouse’s feminism-oriented “cultural” approach unpalatable. Paul T. Durbin Dr. Durbin is professor of philosophy at the University of Delaware, where he also directs the Medical Scholars Program and is a member of the Center for Energy and Environmental Policy. He edits the Society for Philosophy and Technology’s quarterly electronic journal (http://scholar.lib.vt.edu/ejournals/SPT/spt.html) and is the author of Social Responsibility in Science, Technology, and Medicine (Bethlehem, Pa.: Lehigh University Press, 1992). Footnotes * Permission to reprint a review published here may be obtained only from the reviewer. Copyright © 1998 Society for the History of Technology

Public Assistance as Family Policy: Closing Off Options for Poor Families

Journal Article Public Assistance as Family Policy: Closing Off Options for Poor Families Get access Paula Allen-Meares, Paula Allen-Meares Paula Allen-Meares, PhD, LCSW, is dean and professor. University of Michigan School of Social Work, 1065 Frieze Building, Ann Arbor, MI 48109-1285. Eric M. Roberts is MD/PhD candidate, University of Illinois School of Social Work and Medical Scholars Program, Urbana. Search for other works by this author on: Oxford Academic PubMed Google Scholar Eric M. Roberts Eric M. Roberts Paula Allen-Meares, PhD, LCSW, is dean and professor. University of Michigan School of Social Work, 1065 Frieze Building, Ann Arbor, MI 48109-1285. Eric M. Roberts is MD/PhD candidate, University of Illinois School of Social Work and Medical Scholars Program, Urbana. Search for other works by this author on: Oxford Academic PubMed Google Scholar Social Work, Volume 40, Issue 4, July 1995, Pages 559–565, https://doi.org/10.1093/sw/40.4.559 Published: 01 July 1995 Article history Accepted: 13 January 1994 Published: 01 July 1995

Recognition for completing the International Medical Scholars Program

Recognition for completing the International Medical Scholars Program

Implementation of the International Medical Scholars Program

Implementation of the International Medical Scholars Program

The International Medical Scholars Program: purpose and potential.

Among medical leaders in other countries, there is a general perception that it is difficult at present for their citizens to get graduate medical education in the United States. In response to concern that current U.S. policies may be negatively affecting opportunities for international medical education, a task force recommendation of the Accreditation Council for Graduate Medical Education led to the founding of a managing structure through which to develop the International Medical Scholars Program (IMSP). IMSP is described as an organization that will be able to provide tailored opportunities for high-quality education, centralized matching, planning, and evaluation; certificates for recognition of program completion; mechanisms to ensure the return of participants to their home countries; and a system to record the careers of IMSP graduates in their home countries. Proposed eligibility requirements for foreign medical graduates and selection criteria for U.S. institutions are discussed, along with obligations and requirements of program participants, program content, and the recognition for completion of IMSP programs. Administrative considerations also are presented, including IMSP financing and evaluation plans.

Implementation of the International Medical Scholars Program

Implementation of the International Medical Scholars Program

The International Medical Scholars Program: Purpose and Potential

The International Medical Scholars Program: Purpose and Potential