Medical School Research Research Articles

Differences in the Academic Attributes of Matched and Unmatched Orthopaedic Surgery Residency Applicants are Narrowing.

Applicant data from the National Resident Matching Program from 2016 to 2022 were analyzed. The number of matched and unmatched US allopathic senior orthopaedic applicants relative to the number of available positions was used to determine respective match rates. Performance metrics and applicant characteristics were compared by match status. Trends were compared with those of previous analysis from 2006 to 2014. The number of applicants increased from 863 in 2016 to 1,068 in 2022. The match rate decreased from 75% in 2016 to 66% in 2022 (p < 0.0001). Matched applicants had a higher number of contiguous ranks (12.3 vs. 6.5; p < 0.001), United States Medical Licensing Examination (USMLE) Step-1 score (248 vs. 240; p < 0.001), USMLE Step-2 score (255 vs. 247; p < 0.001), Alpha Omega Alpha (AOA) membership (38% vs. 13%; p < 0.001), and enrollment at a top 40 National Institutes of Health (NIH)-funded medical school (34% vs. 24%, p < 0.001). Compared with 2006 to 2014 data, a smaller percentage of matched applicants were enrolled in a top 40 NIH-funded medical school (34% vs. 37%, p = 0.013). The mean differences in USMLE Step-1 score (16 vs. 8.25 points, p < 0.001) and USMLE Step-2 score (16 vs. 8.25 points, p = 0.002) in favor of matched applicants nearly halved compared with that in 2006 to 2014. In addition, there was no longer a significant difference in the number of research products (abstracts, presentations, posters, and publications) between matched and unmatched applicants (p = 0.309). Differences in the academic attributes of matched and unmatched orthopaedic surgery applicants have become less profound over time, making it increasingly difficult to predict a successful match based on USMLE Step scores, AOA membership, research productivity, and medical school research reputation. Future studies should evaluate differences in subjective metrics (e.g., away rotation and interview performance and letters of recommendation) by match status.

Developing a video expert panel as a reference standard to evaluate respiratory rate counting in paediatric pneumonia diagnosis: protocol for a cross-sectional study

IntroductionManual counting of respiratory rate (RR) in children is challenging for health workers and can result in misdiagnosis of pneumonia. Some novel RR counting devices automate the counting of RR...

Effectiveness of an online module: climate-change and sustainability in clinical practice

BackgroundClimate change has significant implications for health, yet healthcare provision itself contributes significant greenhouse gas emission. Medical students need to be prepared to address impacts of the changing environment and fulfil a key role in climate mitigation. Here we evaluate the effectiveness of an online module on climate-change and sustainability in clinical practice designed to achieve learning objectives adapted from previously established sustainable healthcare priority learning outcomes.MethodsA multi-media, online module was developed, and 3rd and 4th year medical students at Brighton and Sussex Medical School were invited to enrol. Students completed pre- and post-module questionnaires consisting of Likert scale and white space answer questions. Quantitative and qualitative analysis of responses was performed.ResultsForty students enrolled and 33 students completed the module (83% completion rate). There was a significant increase in reported understanding of key concepts related to climate change and sustainability in clinical practice (p < 0.001), with proportion of students indicating good or excellent understanding increasing from between 2 – 21% students to between 91 – 97% students. The majority (97%) of students completed the module within 90 min. All students reported the module was relevant to their training. Thematic analysis of white space responses found students commonly reported they wanted access to more resources related to health and healthcare sustainability, as well as further guidance on how to make practical steps towards reducing the environmental impact within a clinical setting.ConclusionThis is the first study to evaluate learner outcomes of an online module in the field of sustainable health and healthcare. Our results suggest that completion of the module was associated with significant improvement in self-assessed knowledge of key concepts in climate health and sustainability. We hope this approach is followed elsewhere to prepare healthcare staff for impacts of climate change and to support improving the environmental sustainability of healthcare delivery.Trial registrationStudy registered with Brighton and Sussex Medical School Research Governance and Ethics Committee (BSMS RGEC). Reference: ER/BSMS3576/8, Date: 4/3/2020.

Matching into Orthopedic Surgery in the U.S. Navy: A Review of Applicant Selection Criteria.

The U.S. Navy offers an attractive opportunity for residency training in orthopedic surgery. The factors that Navy orthopedic residency program leadership finds important in applicant selection for training have not been reported. Additionally, data regarding the academic competitiveness of recently matched applicants have not been previously published. This study presents the results of two surveys administered to all navy orthopedic program directors and department chairmen, as well as data for United States Medical Licensing Examination (USMLE) Steps 1 and 2, medical school class percentile, leadership responsibilities, research endeavors, and letters of recommendation of both matched and unmatched applicants. Two anonymous surveys were administered to all program directors and department chairmen at Navy orthopedic residency training programs with questions designed to gauge perceived importance of various application factors when selecting for the match. The results were compiled, and mean levels of importance were reported. Deidentified data were collected on all applicants to Navy orthopedic residency programs from 2015 to 2019. Data points specific to USMLE Step 1 and 2 board scores, medical school class percentile, research, leadership, and letters of recommendation were analyzed using single and multiple logistic regression analyses, and odds ratios for each variable were calculated. Navy leadership unanimously expressed that clerkship performance at the individual program director's institution was most important, followed by Steps 1 and 2 licensing examination scores. Single logistic regression analyses showed that Step 1 score and clinical, leadership, and recommendation scores were statistically significant. When controlled for Step 1 score, only academic performance and leadership scores maintained statistical significance. Applicants to Navy orthopedic surgery residency programs should strive to be competitive in all aspects of their application, with specific emphasis placed on outstanding performance during orthopedic clerkships, demonstration of leadership characteristics, and academic excellence. With transition to a pass/fail grading system for Step 1, there will be more emphasis on other measures of academic success, such as Step 2 scores and clinical clerkship grades.

A Novel Method to Characterize Medical School Research Productivity among Radiation Oncology Residents

<h3>Purpose</h3> Altmetric score (AS) is a weighted average of the number of mentions on various websites, such as news outlets and social media, for publications. Prior studies have used h-index as a proxy for research impact, which relies on citation counts that may take years to accrue to a meaningful level. However, AS has been shown to follow social media dissemination trends, with a sharp increase in score upon publication followed by a rapid taper. The authors aim to explore research productivity of radiation oncology (RO) residents during their time in medical school using AS. <h3>Methods</h3> A PubMed search was performed for every RO resident in the class of 2024 to collect manuscripts published during medical school (January 1st, 2016 to December 31st, 2019). Extensive metadata were captured for each article, including AS and number of mentions on social media and other websites. Residents who completed a PhD or took longer than four years to graduate were excluded. Medical schools were divided into US News Top-40 and non-Top-40 schools. <h3>Results</h3> A total of 129 residents from 67 residency programs published 665 articles during medical school. Each resident published articles that accrued a mean total AS of 60.4 and an average AS of 9.9 per article. Residents who graduated from Top-40 medical schools obtained significantly higher total AS (p<0.001) and average AS (p<0.001) than those who graduated from non-Top-40 schools. While only 39.5% of residents graduated from Top-40 institutions, 55.4% of articles with the highest quartile of AS were published by those from these schools. <h3>Discussion</h3> The results of using AS to measure the impact of manuscripts published by RO residents appear to be consistent with those of traditional bibliometric studies. Residents from higher-ranked medical schools published more higher-impact articles than their counterparts from lower-ranked medical schools. Limitations of the study include possible differences in AS at time of residency application vs. current day and lack of control for possible confounders (e.g. possible increased research interest in Top-40 school students). Our data again suggests that students who attend higher-tier medical schools may have an advantage in access to potentially higher-impact research opportunities. With the recent shift of the Step 1 exam to a pass/fail format, there may be more emphasis placed on extracurricular activities such as research. Further work is needed to understand the optimal method by which holistic review can be incorporated into the RO residency selection process.

Research Productivity of Integrated Plastic Surgery Residents: Does Reputation Matter?

It is unknown whether the ranking of plastic surgery residency programs influences resident research output. This study aims to determine whether program reputation and other factors are associated with integrated plastic surgery resident academic productivity. Programs were divided into four tiers based on Doximity reputation rankings. Residents from 2019 to 2020 were found through program websites and social media accounts. Works published during residency were identified through PubMed and Scopus from July 1 of each resident's intern year to August 10, 2020. Variables included resident demographics and medical school, residency reputation ranking, geographic region, and medical school affiliation. 'High research output' was defined as having ≥75th percentile of publications adjusted by training year. In total, 921 residents in 80 programs were identified. The median (IQR) number of total publications and original articles was 3 (1-6) and 2 (0-4), respectively. On multivariable analysis, residents in top-20 ranked programs (OR=2.31, 95% CI [1.55; 3.43], P<0.001) or from programs associated with top-20 medical schools (OR=1.61, 95% CI [1.08; 2.41], P=0.020) were more likely to have higher research output. On the other hand, coming from a top-50 in research medical school (OR=1.80, 95% CI [1.31; 2.47], P<0.001) or being in a program affiliated with a top-20 medical school (OR=2.52, 95% CI [1.69; 3.78], P<0.001) were associated with higher original article output. Gender and geographic location were not associated with higher research output. Program reputation and affiliated medical school research rankings are associated with research productivity during integrated plastic surgery residency. Applicants with a particular interest in research careers may consider this as they apply to residency.

Fourth Dose of BNT162b2 mRNA Covid-19 Vaccine in a Nationwide Setting

BackgroundWith large waves of infection driven by the B.1.1.529 (omicron) variant of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), alongside evidence of waning immunity after the booster dose of coronavirus disease 2019 (Covid-19) vaccine, several countries have begun giving at-risk persons a fourth vaccine dose.MethodsTo evaluate the early effectiveness of a fourth dose of the BNT162b2 vaccine for the prevention of Covid-19–related outcomes, we analyzed data recorded by the largest health care organization in Israel from January 3 to February 18, 2022. We evaluated the relative effectiveness of a fourth vaccine dose as compared with that of a third dose given at least 4 months earlier among persons 60 years of age or older. We compared outcomes in persons who had received a fourth dose with those in persons who had not, individually matching persons from these two groups with respect to multiple sociodemographic and clinical variables. A sensitivity analysis was performed with the use of parametric Poisson regression.ResultsThe primary analysis included 182,122 matched pairs. Relative vaccine effectiveness in days 7 to 30 after the fourth dose was estimated to be 45% (95% confidence interval [CI], 44 to 47) against polymerase-chain-reaction–confirmed SARS-CoV-2 infection, 55% (95% CI, 53 to 58) against symptomatic Covid-19, 68% (95% CI, 59 to 74) against Covid-19–related hospitalization, 62% (95% CI, 50 to 74) against severe Covid-19, and 74% (95% CI, 50 to 90) against Covid-19–related death. The corresponding estimates in days 14 to 30 after the fourth dose were 52% (95% CI, 49 to 54), 61% (95% CI, 58 to 64), 72% (95% CI, 63 to 79), 64% (95% CI, 48 to 77), and 76% (95% CI, 48 to 91). In days 7 to 30 after a fourth vaccine dose, the difference in the absolute risk (three doses vs. four doses) was 180.1 cases per 100,000 persons (95% CI, 142.8 to 211.9) for Covid-19–related hospitalization and 68.8 cases per 100,000 persons (95% CI, 48.5 to 91.9) for severe Covid-19. In sensitivity analyses, estimates of relative effectiveness against documented infection were similar to those in the primary analysis.ConclusionsA fourth dose of the BNT162b2 vaccine was effective in reducing the short-term risk of Covid-19–related outcomes among persons who had received a third dose at least 4 months earlier. (Funded by the Ivan and Francesca Berkowitz Family Living Laboratory Collaboration at Harvard Medical School and Clalit Research Institute.)

Remote data collection speech analysis and prediction of the identification of Alzheimer’s disease biomarkers in people at risk for Alzheimer’s disease dementia: the Speech on the Phone Assessment (SPeAk) prospective observational study protocol

IntroductionIdentifying cost-effective, non-invasive biomarkers of Alzheimer’s disease (AD) is a clinical and research priority. Speech data are easy to collect, and studies suggest it can identify those with AD. We...

Institution Origin and Medical School Rank Impact the Citation Frequency and Publication Rate in Orthopaedic Sports Medicine Journals

PurposeTo examine the trends between various categories of institutions with their respective published orthopaedic sports medicine content and to determine the publication output and citation rate from the 25 highest-ranked medical schools compared with lower-ranked institutions.MethodsPublications between 2015 and 2019 from the American Journal of Sports Medicine, Journal of Bone and Joint Surgery, Journal of Shoulder and Elbow Surgery, Clinical Orthopaedics and Related Research, and Arthroscopy were categorized into university/university affiliated hospitals, non-university affiliated teaching hospitals, public/semi-government research institutes, nonprofit research institutes, private sector institutions, government institutions, and other institutions. Citation rates were collected from PubMed for the first and corresponding author. Similarly, corresponding authors were stratified by U.S. News and World Report 2021 medical school research rankings.ResultsOf the 12,152 publications identified, 5,044 publications met the inclusion criteria. Nonprofit research institutions garnered the greatest number of citations on average (6.44 based on first author, SD 8.83, n = 214; 6.62 based on corresponding author, SD 9.65, n = 208; P < .001), while university/university-affiliated hospitals produced the majority of published articles (77.0% based on first author, 76.8% based on corresponding author), but had lower average citation rates (4.48 based on first author, SD 6.67, n = 3,886; 4.44 based on corresponding author, SD 6.55, n = 3,873; P < .001). Furthermore, of 1953 medical school publications, the top 25 accounted for 53.1% of publications; however, there was no statistical difference between their citation rates and those of lower rankings (P = 0.47).ConclusionsPublications are cited at different rates, depending on their institution of origin. In addition, high-ranking medical schools produce a disproportionately greater output of publications than lower-ranking schools, but there is no statistically significant difference in citation rates on an individual publication basis.Clinical RelevanceKnowing how an institution’s ranking influences publication and citation rates can help us understand bias in the scientific literature.

Is AST/ALT Ratio a Predictor of In-hospital Mortality in Pulmonary Embolism Patients?

To document the association between serum transaminases and in-hospital mortality in pulmonary embolism (PE) patients. Analytical study. Patients treated with acute PE in hospital between January 2011 and December 2019 from Sakarya University Medical School Research and Teaching Hospital, Sakarya, Turkey. Patients with PE were included. Receiver operating characteristics (ROC) analysis was conducted to define a cut-off value for AST/ALT ratio to predict in-hospital death. Simplified pulmonary embolism severity index (sPESI) scores were calculated and the AST/ALT ratio were entered into binary logistic regression analysis with components of sPESI score to document the prognostic significance of as an independent predictor of in-hospital mortality. 164 acute PE patients were included; of those, 33 (20%) died in hospital. Deceased patients had higher AST/ALT ratio (median, 1.4; 25th-75th percentile, 1.1-1.8) comparing to patients with discharged home (median, 1.1; 25th-75th percentile, 0.84-1.4) (p=0.006). ROC analysis showed that AST/ALT ratio was an indicator of in-hospital mortality, and the calculated area under the curve was 0.655 (95% CI, 0.547-0.764). The cut-off value of 1.3 was associated with a prognostic sensitivity of 61% and specificity of 65%. Binary logistic regression analysis failed to show AST/ALT ratio as an independent predictor of in-hospital mortality. AST/ALT ratio predicts in-hospital mortality with acceptable sensitivity and specificity in patients with acute PE and might be used as a biomarker for risk stratification. Key Words: Pulmonary embolism, In-hospital mortality, Transaminases.

Dental education and special dental practitioner-cultivating system in Taiwan during the Japanese colonial period

Background/purposeDuring the Japanese colonial period, Taiwan had no dental school but had a medical school. This study explored the dental education and research activities in the medical school and special dentist qualification system in Taiwan during the Japanese colonial period. Materials and methodsThis study analyzed the “related incidents and documents of dental education and research and dentist qualification system in Taiwan during the Japanese colonial period” and explored the dental education and research activities in the medical school and special dentist qualification system in Taiwan during the Japanese colonial period. ResultsIn 1914, Taiwan Government Medical School hired Dr. Kaname Ansawa, the earliest dental teacher in Taiwan, to teach dental courses in the medical school. In 1918, the “Theory of Dentistry” was considered to be the first independent “Dentistry” subject in the medical school. In 1936, the Faculty of Medicine of Taipei Imperial University listed “Dentistry & Oral Surgery” as an independent graduation examination subject. For dentist qualification system, a qualified physician who had finished dental courses and training could apply for a dental specialty license to work as a dentist. Taiwan Government Medical School (Dentistry) Research Department was the earliest department involved in the teaching and research of dentistry in the medical school and was also an educational institution for cultivating dental practitioners in Taiwan. ConclusionIn the Japanese colonial period, although no dental school was established in Taiwan, there were rich dental education and research activities in the medical school and a special dentist qualification system.

Medical Students' Confidence in Their Abilities and Barriers to Conducting Research: A Mixed-Methods Study.

BackgroundMedical students’ confidence in their ability to conduct research has been speculated to be a significant factor influencing the engagement of research, yet their confidence may remain low. Moreover, it is unclear what barriers exist to high engagement in research before graduation. Hence, the objective of this study was to investigate medical students’ attitudes, confidence, and perceived barriers regarding conducting research.MethodologyA cross-sectional study was conducted using quantitative and qualitative methods to investigate medical students’ attitudes, confidence, and perceived barriers regarding doing research. Quantitative data were collected from 141 first-year medical students via an online questionnaire in September 2020 asking about their perceptions toward participating in research while in school. Linear regression was performed to determine if certain perceptions and self-reported abilities would significantly contribute to research confidence. Additionally, focus groups were conducted with 30 students to assess student perceptions toward engaging in research. For qualitative data, an inductive thematic analysis was performed to allow for the patterns, themes, and categories to emerge.ResultsRegression modeling successfully explained 71% of the variance in predicting research confidence [F(3,137) = 116.91, p < 0.01] with an R2 of 0.719 (adjusted R2 = 0.713). Feeling secure in one’s research knowledge, greater belief in the ability to conduct research, and feeling research was important for their future career significantly contributed to greater research confidence. Five themes related to student attitudes and perceived barriers to conducting research in medical school emerged from the qualitative interviews.ConclusionsFindings from this study may help medical educators better understand which attitudes are prevalent among medical students that may influence their confidence and ultimately affect their engagement in research during preclinical training. Unblocking barriers to research engagement and incorporating curricular strategies to help students gain practical experience and confidence in their research abilities may be warranted.

Do Dedicated Research Years during Medical School Predict Academic Productivity during Residency?

Background:Evidence regarding whether medical school research portends resident research is limited. This information will provide program directors with data that may be useful for selecting applicants with a commitment to continued academic productivity.Methods:A questionnaire distributed via the American Society of Plastic Surgeons Resident Council to residents in 44 plastic surgery training programs in May 2020 assessed participation in dedicated research years during medical school, the number of publications completed before residency, and the total number of publications by each resident at the time of the survey. One-way ANOVA and post hoc analysis determined significant associations between publication count and number of research years.Results:Of the 256 included respondents, 203 did not complete a research year during medical school, 44 completed 1 research year, and nine completed 2 research years. Mean publications before residency were higher for participants who took 1 or 2 research years (9.88 and 27.60, respectively) compared with those who did not (4.83, P < 0.001). A comparison of total publications during residency similarly revealed increased productivity by individuals who took 1 or more research years; however, there was no difference between the number of publications completed during residency for individuals who took 1 versus 2 years (P = 0.23).Conclusions:Residents with research experience during medical school continue to produce an increased number of publications during residency compared with those without, suggesting dedicated research years taken during medical school serve as a predictor of academic productivity in plastic surgery residents.

Motivating Factors of and Perceived Barriers to Research at a Canadian Medical University with Regional Campuses: A Cross-Sectional Survey Study

Introduction&#x0D; Research training programs are an integral part of a well-rounded medical education. These programs help students contribute to medical knowledge, develop skills in critical evaluation and research dissemination, and they facilitate the training of our future medical researchers. Existing literature suggests barriers including lack of available time and access to projects may hinder a medical student’s research training. These barriers likely differ based on the medical school curriculum, and there exists limited data looking at these attitudes in Canadian students, students outside large academic centers or those in condensed programs. Given this, our study aims to further explore medical students' perceptions, perceived barriers of research in a three-year Canadian undergraduate medical school with regional campuses.&#x0D; &#x0D; Methods&#x0D; We conducted a cross-sectional survey of medical students (classes of 2019, 2020 and 2021) representing the main and regional campuses of the Michael G. DeGroote School of Medicine in Ontario, Canada to explore their attitudes towards research. Descriptive statistics were used to describe participant demographics, research background and attitudes towards research.&#x0D; &#x0D; Results&#x0D; Overall, 70.4% of students identified as being involved in a research project at some point during their medical school tenure. Motivating factors for research participation included the goal of obtaining a residency spot (63.0%), and interest in their research topic (74.7%). Barriers to research included perceived lack of available time (31.5%), and difficulty in finding a research project (44.5%). Perceived curriculum deficiencies included lack of education in research methodology and appraisal of scientific literature (93.2% and 89.0%, respectively). Lastly, regional campuses tended conduct their research outside of their home campus (43.6% vs 3.3%, p&lt;0.0001).&#x0D; &#x0D; Conclusion&#x0D; The findings from our study highlighted the students’ attitudes towards research in a Canadian medical school that has multiple campuses and a shortened medical curriculum (3-year). It identifies potential areas of improvement from a student perspective, which can hopefully be utilized by medical educators to continue the improvement of medical trainee research training.

Myocarditis after Covid-19 Vaccination in a Large Health Care Organization

BackgroundReports have suggested an association between the development of myocarditis and the receipt of messenger RNA (mRNA) vaccines against coronavirus disease 2019 (Covid-19), but the frequency and severity of myocarditis after vaccination have not been extensively explored.MethodsWe searched the database of Clalit Health Services, the largest health care organization (HCO) in Israel, for diagnoses of myocarditis in patients who had received at least one dose of the BNT162b2 mRNA vaccine (Pfizer–BioNTech). The diagnosis of myocarditis was adjudicated by cardiologists using the case definition used by the Centers for Disease Control and Prevention. We abstracted the presentation, clinical course, and outcome from the patient’s electronic health record. We performed a Kaplan–Meier analysis of the incidence of myocarditis up to 42 days after the first vaccine dose.ResultsAmong more than 2.5 million vaccinated HCO members who were 16 years of age or older, 54 cases met the criteria for myocarditis. The estimated incidence per 100,000 persons who had received at least one dose of vaccine was 2.13 cases (95% confidence interval [CI], 1.56 to 2.70). The highest incidence of myocarditis (10.69 cases per 100,000 persons; 95% CI, 6.93 to 14.46) was reported in male patients between the ages of 16 and 29 years. A total of 76% of cases of myocarditis were described as mild and 22% as intermediate; 1 case was associated with cardiogenic shock. After a median follow-up of 83 days after the onset of myocarditis, 1 patient had been readmitted to the hospital, and 1 had died of an unknown cause after discharge. Of 14 patients who had left ventricular dysfunction on echocardiography during admission, 10 still had such dysfunction at the time of hospital discharge. Of these patients, 5 underwent subsequent testing that revealed normal heart function.ConclusionsAmong patients in a large Israeli health care system who had received at least one dose of the BNT162b2 mRNA vaccine, the estimated incidence of myocarditis was 2.13 cases per 100,000 persons; the highest incidence was among male patients between the ages of 16 and 29 years. Most cases of myocarditis were mild or moderate in severity. (Funded by the Ivan and Francesca Berkowitz Family Living Laboratory Collaboration at Harvard Medical School and Clalit Research Institute.)

Student Research Mentorship Programme: A Novel Solution for Promoting Research in Medical School.

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Safety of the BNT162b2 mRNA Covid-19 Vaccine in a Nationwide Setting

BackgroundPreapproval trials showed that messenger RNA (mRNA)–based vaccines against severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) had a good safety profile, yet these trials were subject to size and patient-mix limitations. An evaluation of the safety of the BNT162b2 mRNA vaccine with respect to a broad range of potential adverse events is needed.MethodsWe used data from the largest health care organization in Israel to evaluate the safety of the BNT162b2 mRNA vaccine. For each potential adverse event, in a population of persons with no previous diagnosis of that event, we individually matched vaccinated persons to unvaccinated persons according to sociodemographic and clinical variables. Risk ratios and risk differences at 42 days after vaccination were derived with the use of the Kaplan–Meier estimator. To place these results in context, we performed a similar analysis involving SARS-CoV-2–infected persons matched to uninfected persons. The same adverse events were studied in the vaccination and SARS-CoV-2 infection analyses.ResultsIn the vaccination analysis, the vaccinated and control groups each included a mean of 884,828 persons. Vaccination was most strongly associated with an elevated risk of myocarditis (risk ratio, 3.24; 95% confidence interval [CI], 1.55 to 12.44; risk difference, 2.7 events per 100,000 persons; 95% CI, 1.0 to 4.6), lymphadenopathy (risk ratio, 2.43; 95% CI, 2.05 to 2.78; risk difference, 78.4 events per 100,000 persons; 95% CI, 64.1 to 89.3), appendicitis (risk ratio, 1.40; 95% CI, 1.02 to 2.01; risk difference, 5.0 events per 100,000 persons; 95% CI, 0.3 to 9.9), and herpes zoster infection (risk ratio, 1.43; 95% CI, 1.20 to 1.73; risk difference, 15.8 events per 100,000 persons; 95% CI, 8.2 to 24.2). SARS-CoV-2 infection was associated with a substantially increased risk of myocarditis (risk ratio, 18.28; 95% CI, 3.95 to 25.12; risk difference, 11.0 events per 100,000 persons; 95% CI, 5.6 to 15.8) and of additional serious adverse events, including pericarditis, arrhythmia, deep-vein thrombosis, pulmonary embolism, myocardial infarction, intracranial hemorrhage, and thrombocytopenia.ConclusionsIn this study in a nationwide mass vaccination setting, the BNT162b2 vaccine was not associated with an elevated risk of most of the adverse events examined. The vaccine was associated with an excess risk of myocarditis (1 to 5 events per 100,000 persons). The risk of this potentially serious adverse event and of many other serious adverse events was substantially increased after SARS-CoV-2 infection. (Funded by the Ivan and Francesca Berkowitz Family Living Laboratory Collaboration at Harvard Medical School and Clalit Research Institute.)

Midcareer Medical School Research Faculty Perspectives on Vitality and Professionalism During the COVID-19 Pandemic

As medical faculty have central roles during the COVID-19 pandemic, it is important to study the pandemic's association with the vitality and careers of medical school faculty. To examine how the COVID-19 pandemic affected midcareer research faculty in academic medicine. This qualitative study included medical school faculty who participated in the C-Change Mentoring and Leadership Institute. All US medical school faculty recipients of recent National Institutes of Health (NIH) RO1, RO1-equivalent, and K awards were invited to apply to the institute. The 99 applicants who met inclusion criteria were stratified by degree (MD or MD/PhD vs PhD), gender, and race/ethnicity. Enrollment was offered to applicants randomly selected for 40 spots, demographically balanced by sex, underrepresented in medicine minority (URMM) status, and degree. In April 2020, an inquiry was emailed to faculty enrolled in the institute requesting responses to questions about meaning in work, career choice, and values. A qualitative analysis of narrative data responses, using grounded theory, was undertaken to determine key themes. This study is part of a NIH-funded randomized trial to test the efficacy of a group peer mentoring course for midcareer faculty and study the course's mechanisms of action. Key themes in data. Of 40 enrolled participants, 39 responded to the inquiry, for a response rate of 97%. The analytic sample included 39 faculty members; 19 (47%) were women, 20 (53%) identified as URMM, and 20 (53%) had an MD or MD with PhD vs 19 (47%) with PhD degrees. Key themes in the data that emerged describing faculty lived experience of the pandemic included increased meaningfulness of work; professionalism and moral responsibility; enhanced relationships with colleagues; reassertion of career choice; disrupted research; impact on clinical work; attention to health disparities, social justice and advocacy; increased family responsibilities; psychological stress; and focus on leadership. During the pandemic, diverse PhD and physician investigators reported increased meaningfulness in work and professionalism and enhanced relationships, all intrinsic motivators associated with vitality. Working during the pandemic appears to have produced intrinsic rewards positively associated with vitality, in addition to adverse mental health effects. These findings have implications for combatting burnout and retaining investigators in the future.

The experiences, attitudes and understanding of research amongst medical students at an Australian medical school

BackgroundResearch engagement plays an integral role in developing clinicians that practice effective, evidence-based medicine. Research participation by clinicians, however, is declining. Given the link between research during medical school and future research output, promotion of medical student research is one avenue by which this shortage can be addressed. Student research attitudes and participation in Australia are not well-documented in the literature. This study therefore aims to investigate research practices, motivators, and barriers amongst Australian medical students in order to determine whether there is a need for further integration of research within Australian medical school curriculums.MethodsA cross-sectional study design was used to explore research experience and attitudes, as well as the enablers and barriers to research amongst students enrolled in all years of the five-year medical course at Monash University. A questionnaire was created by combining questions from several surveys on medical student research and comprised Likert scales, multiple choice options and free-text responses assessing research experience, attitudes, motivators, and barriers.ResultsSeven hundred and four respondents (69.4% female; survey response rate 36.7%) reported variable research experience and interest. Less than half of the cohort (n = 296; 44.9%) had contributed to a research project. Increasing employability for specialty training programs was the primary motivating factor (n = 345; 51.9%) for pursuing research, with only 20.5% (n = 136) citing an interest in academia as a motivator. Time constraints (n = 460; 65.3%) and uncertainty surrounding how to find research opportunities (n = 449; 63.8%) were the most common barriers to research.ConclusionsMedical students at Monash University are interested in but have limited experience with research. Students are, however, primarily motivated by the prospect of increasing employability for specialist training; medical schools should therefore focus on encouraging intrinsic motivation for pursuing research. Greater integration of research education and opportunities within medical school curricula may also be required to provide students with the skills necessary to both pursue research and practice evidence-based medicine.

189 Preliminary Results from an Innovative Surgical Research Group for Medical Students

Abstract Introduction Learning research in medical school can be daunting and difficult with many lacking appropriate guidance. Particularly, research in surgery can be difficult with most clinicians tied to long hours from clinical duties, leaving medical students lost to learn the ropes for medical research. Method We started a surgical research group in January of 2020 under a shepherd sheep model. Shepards were senior medical students who had previous experience in research and were provided resources from consultants on statistics and research designs. Thereafter, each Shepard were paired with junior medical students (sheep) and a resident to provide clinical background. Research was then carried out small teams with minimal guidance from consultants. Results To date, the group has published 11 articles (median impact factor: 2.41, range: 1.89 - 3.42), 3 articles in revision and 9 articles in review. Conclusions We provide preliminary evidence of a successful model for building medical student research in surgery. While current analysis was limited to meta-analysis and systematic review due to the availability of data, current expansion is currently underway to expand to observational studies.