Medicine Residents Research Articles

Living the Dream I Never Knew I Wanted

Back to table of contents Previous article Why I Aspired to Be a PsychiatristFull AccessLiving the Dream I Never Knew I WantedD. Andrew Tompkins,M.D., M.H.S.D. Andrew Tompkins,Search for more papers by this authorM.D., M.H.S.Published Online:26 Oct 2017https://doi.org/10.1176/appi.pn.2017.11a12AbstractI can remember wanting to be a doctor at 5 years old. Being one of the great nerds of Shawnee Mission, I was constantly in the library or classroom. These locations were my safe havens from the bullies who made fun of my effeminate nature and allowed my curiosity to multiply. In between reading almost every book in my public library, I planned my life. By sixth grade, I knew when the SAT should be taken, the names of my favorite Ivy League schools, the age when I would enter medical school (22), the age when I would finish my medicine residency (29), and where I would practice (suburban Kansas City, Kan.) the entirety of my adulthood. This life course was written down using childish cursive in my first autobiography. Thankfully, my life’s journey took many twists and turns away from those sixth grade preconceptions. First, I discovered that I was gay and gradually developed an acceptance of my sexual orientation. I took this chance of self-acceptance only after all of the Ivy League schools had the audacity to reject my first round of medical school applications. After I moved back into my parent’s house following college graduation, my father offered me two choices. I could work on one of the asphalt paving crews in his company while living at home or obtain an alternate job and residence. Not wanting to waste my liberal arts education, I threw a dart at a U.S. map, and it landed near Baltimore. Having never been to the mid-Atlantic, I applied for a laboratory technician job at Johns Hopkins University and was hired after a simple phone interview. I moved to Baltimore knowing no one. During that year of employment, I was exposed to psychiatry for the first time. I shadowed a psychiatrist as he took care of patients on the inpatient chronic pain unit. After months of physical and occupational therapy, group therapy, individual therapy, and detoxification from opioids, sedatives, and unnecessary psychotropic medications, I saw a woman walk for the first time in over 15 years. This psychiatrist and his team made the lame walk again—an experience that has shaped my career and made me aspire to do the same. Second, I moved to New York City to attend New York Medical College. As a medical student, I joined the board of the Association of Gay and Lesbian Psychiatrists (now AGLP) because it came with travel funds to conferences. In this role, I met the scientists and researchers who lobbied for APA to remove homosexuality from DSM, including Drs. Barbara Gittings and John Fryer. My schooling and the AGLP showed me that psychiatrists could be excellent clinicians, advocates, administrators, and world-renowned researchers. My career path was set.Third, I returned to Johns Hopkins for psychiatry residency, fellowship, and my first seven years on faculty. I ended up specializing in addictions and developed my own research interests at the intersection of chronic pain and addiction. During my medical training, our country became embroiled in the twin epidemics of chronic pain and opioid overdose deaths. Due to my training and strong mentorship, I became uniquely qualified to develop collaborative solutions to these epidemics.All the bullies, medical school rejections, and one large leap of faith have led me away from my rigid sixth grade life course and toward where I am needed most. I am the newly appointed director of the Division of Substance Abuse and Addiction Medicine at Zuckerberg San Francisco General Hospital—a dream job for this psychiatrist and a platform for solution building. My work has just begun. ■D. Andrew Tompkins, M.D., M.H.S., is director of the Division of Substance Abuse and Addiction Medicine at Zuckerberg San Francisco General and an associate clinical professor of psychiatry at the UCSF School of Medicine. ISSUES NewArchived

299 Interobserver Reliability of Assigning NIHSS Between Emergency Medicine and Neurology Residents

299 Interobserver Reliability of Assigning NIHSS Between Emergency Medicine and Neurology Residents

Editorial introductions

Current Opinion in Gastroenterology was launched in 1985. It is one of a successful series of review journals whose unique format is designed to provide a systematic and critical assessment of the literature as presented in the many primary journals. The field of gastroenterology is divided into 12 sections that are reviewed once a year. Each section is assigned a Section Editor, a leading authority in the area, who identifies the most important topics at that time. Here we are pleased to introduce one of the Section Editors for this issue. SECTION EDITORS Anthony KallooAnthony KallooDr Anthony Kalloo is a Professor of Medicine at Johns Hopkins University, USA. He is the Director of The Division of Gastroenterology and Hepatology at Johns Hopkins Hospital. He has special interests in natural orifice surgery, therapeutic endoscopy, biliary and pancreatic diseases and sphincter of Oddi dysfunction. After receiving his medical degree from the University of West Indies Medical School, West Indies, Dr Kalloo interned and completed his residency in internal medicine at Howard University Hospital in Washington, DC, USA. He completed his fellowship training program at the combined Georgetown University, USA, VA Medical Center, USA and NIH program. He was an instructor in medicine at Georgetown University prior to joining the faculty at Johns Hopkins in 1988. He was an associate editor of Gastrointestinal Endoscopy. He is the Founder and Immediate Past Medical Director of The Hopkins Gastroenterology and Hepatology Resource Center (www.hopkins-gi.org), a 3000 page multilingual web resource for patients and physicians. He has authored over 150 scientific papers, review articles and book chapters. He has pioneered and has multiple patents including the use of Botulinum Toxin in the gastrointestinal tract, endoscopic cryotherapy and the winged biliary/pancreatic stent. He is the pioneer of Natural Orifice Translumenal Endoscopic Surgery (NOTES), a technique that will enable abdominal surgery without the use of incisions. Dr Kalloo is a Past Panel Chair for Gastroenterology and Urology Devices with the United States Food and Drug Administration. He is the recipient of the 2009 Distinguished Educator of the Year of the Award from the American Society for Gastrointestinal Endoscopy. Rodger LiddleRodger LiddleDr Rodger Liddle is Professor of Medicine at Duke University Medical Center. Dr Liddle received his medical degree from Vanderbilt University and performed his internship and residency in medicine at the University of California, San Francisco. He was a fellow in gastroenterology at UCSF where he also performed his postdoctoral research training. Dr Liddle has served on the faculties of UCSF and Duke University. At Duke, Dr Liddle has held numerous leadership positions, including Chief of the Gastroenterology Division. Dr Liddle is an internationally recognized investigator in the physiology of the gastrointestinal tract. Dr Liddle's research focuses on neurohormonal regulation of the pancreas and experimental models of pancreatitis.

Internal medicine nurse shadowing program

Abstract Professional identity formation is a fluid process, which evolves throughout one's medical education. Residency is an ideal time for interprofessional education because as junior physicians, they are beginning to develop their professional identity, but it is still early enough in their careers that their attitudes and habits are malleable. We implemented a nurse-shadowing pilot program for internal medicine (IM) residents. IM residents completed a six to 12-h nurse-shadowing experience. Pre- and post-exposure surveys and interviews were used to explore satisfaction, learning, reflective practice, and anticipated change in behaviour. All residents (n = 7) and nurses (n = 7) found the nurse-shadowing experience to be valuable. There was a statistically significant improvement on resident self-reported knowledge of nursing scope of practice. Qualitative analysis of participant interviews identified potential benefits, including reflective practice, attitudinal changes (increased empathy), and recognized specific actionable items to incorporate into their daily practice to improve collaboration and communication. The residents were able to compare and contrast their own roles to those of their nursing colleagues. Nurse-shadowing programs at the residency level provide a valuable interprofessional educational experience.

Assessment of Maxillofacial Trauma in Emergency Department

Background: Maxillofacial trauma is one of the most common traumas with many complications and disabilities. Recognition of the trauma-related mechanisms is the key to early diagnosis and treatment. Objectives: The current study was aimed at assessing maxillofacial trauma in emergency department. Methods: The current cross sectional study was performed on 406 patients with maxillofacial trauma recruited from the emergency department (ED) of Shariati and Imam Khomeini hospitals from January 2014 to March 2015. Demographic data, etiology and mechanism of trauma as well as the type of maxillofacial fractures were recorded by the emergency medicine (EM) residents. Maxillofacial fractures, diagnosed by the computed tomography (CT) scan, were reported by the ED attending radiologist. Results: The current study evaluated 406 patients, 106 females (26.1%) and 300 males (73.9%), with maxillofacial trauma and the mean age of 29.95 ± 15.82 years. The leading causes of maxillofacial trauma were the road traffic accidents (RTA) (50.2%), followed by falling (20.0%) and assault (17.3%). Maxillofacial fractures were detected in 137 patients (33.7%) and mandibular fractures were the most common site (71.5%). The mean age of males was significantly higher than that of females. Some causes of maxillofacial trauma, such as assault and occupational accidents, were significantly common in males than females. The risk of maxillofacial fractures was significantly higher in the traumas caused by pedestrian-car accidents followed by falling and assault. Conclusions: In the current study population, the patterns of underlying causes of maxillofacial traumas were similar to other types of traumas mainly affected by socioeconomic status of the society. RTA was the main cause of maxillofacial trauma and males were affected more than females. Most of the current study patients were in the 3rd and 4th decades of life. Mandible was the site mostly involved in MF fractures.

Aptitud en médicos residentes de Medicina Familiar para la evaluación integradora de la familia

<p><strong>Objetivo:</strong> determinar la aptitud para la evaluación integradora de la familia en un grupo de médicos residentes en Medicina Familiar. <strong>Métodos:</strong> estudio observacional, transversal y comparativo, para el cual se elaboró y validó un instrumento que explora la aptitud para la evaluación integradora de la familia. Su consistencia interna se calculó con la prueba de Kuder-Richardson 20, posterior a una prueba premuestreo, se utilizó la prueba U de Mann-Whitney para comparar las dos mitades del instrumento (semipartición) y corroborar si existía o no diferencia entre ellas. Se determinó el número de posibles respuestas esperadas por el azar con la prueba de Pérez-Padilla y Viniegra. Finalmente el instrumento evaluó a 49 residentes en Medicina Familiar de los tres años de una sede académica. <strong>Resultados:</strong> la consistencia interna del instrumento fue de 0.9. Al hacer la comparación de las dos mitades, se obtuvo una p de 0.47. Al aplicar el instrumento, 65% de la muestra se ubicó en el grado bajo, 25% en el grado muy bajo y 10% en el intermedio. No existieron diferencias estadísticamente significativas entre los tres grados evaluados (p>0.5). <strong>Conclusiones:</strong> el instrumento elaborado es válido y confiable. La aptitud para la evaluación integradora de la familia en los médicos residentes está poco desarrollada, independientemente de los años de experiencia, por lo que es necesario un cambio en la labor docente, apoyándose en estrategias educativas más efectivas.</p>

Use of 3D models of vascular rings and slings to improve resident education.

Three-dimensional (3D) printing is a manufacturing method by which an object is created in an additive process, and can be used with medical imaging data to generate accurate physical reproductions of organs and tissues for a variety of applications. We hypothesized that using 3D printed models of congenital cardiovascular lesions to supplement an educational lecture would improve learners' scores on a board-style examination. Patients with normal and abnormal aortic arches were selected and anonymized to generate 3D printed models. A cohort of pediatric and combined pediatric/emergency medicine residents were then randomized to intervention and control groups. Each participant was given a subjective survey and an objective board-style pretest. Each group received the same 20-minutes lecture on vascular rings and slings. During the intervention group's lecture, 3D printed physical models of each lesion were distributed for inspection. After each lecture, both groups completed the same subjective survey and objective board-style test to assess their comfort with and postlecture knowledge of vascular rings. There were no differences in the basic demographics of the two groups. After the lectures, both groups' subjective comfort levels increased. Both groups' scores on the objective test improved, but the intervention group scored higher on the posttest. This study demonstrated a measurable gain in knowledge about vascular rings and pulmonary artery slings with the addition of 3D printed models of the defects. Future applications of this teaching modality could extend to other congenital cardiac lesions and different learners.

Credentialing and retention of visa trainees in post-graduate medical education programs in Canada

BackgroundVisa trainees are international medical graduates (IMG) who come to Canada to train in a post-graduate medical education (PGME) program under a student or employment visa and are expected to return to their country of origin after training. We examined the credentialing and retention of visa trainees who entered PGME programs between 2005 and 2011.MethodsUsing the Canadian Post-MD Education Registry’s National IMG Database linked to Scott’s Medical Database, we examined four outcomes: (1) passing the Medical Council of Canada Qualifying Examination Part 2 (MCCQE2), (2) obtaining a specialty designation (CCFP, FRCPC/SC), and (3) working in Canada after training and (4) in 2015. The National IMG Database is the most comprehensive source of information on IMG in Canada; data were provided by physician training and credentialing organizations. Scott’s Medical Database provides data on physician locations in Canada.ResultsThere were 233 visa trainees in the study; 39.5% passed the MCCQE2, 45.9% obtained a specialty designation, 24.0% worked in Canada after their training, and 53.6% worked in Canada in 2015. Family medicine trainees (OR = 8.33; 95% CI = 1.69–33.33) and residents (OR = 3.45; 95% CI = 1.96–6.25) were more likely than other specialist and fellow trainees, respectively, to pass the MCCQE2. Residents (OR = 7.69; 95% CI = 4.35–14.29) were more likely to obtain a specialty credential than fellows. Visa trainees eligible for a full license were more likely than those not eligible for a full license to work in Canada following training (OR = 3.41; 95% CI = 1.80–6.43) and in 2015 (OR = 3.34; 95% CI = 1.78–6.27).ConclusionsVisa training programs represent another route for IMG to qualify for and enter the physician workforce in Canada. The growth in the number of visa trainees and the high retention of these physicians warrant further consideration of the oversight and coordination of visa trainee programs in provincial and in pan-Canadian physician workforce planning.

John Canty Jr: A Full Life, Both at Home and in the Lab.

Among scientists and doctors, John Canty Jr, MD, might be best known for his successes in translational cardiology research. But outside the laboratory, in his lifelong hometown of Buffalo, NY, he is more likely to be recognized as the father of any one of his 6 children or the grandfather of 9. In a career where many struggle to balance professional and personal life, Canty has managed to find success in both. As Chief of the Division of Cardiovascular Medicine at the State University of New York at Buffalo, Canty works to bring research from the laboratory bench to the patient’s bedside. His work at the translational interface is broadly focused on understanding and treating ischemic heart disease. In fact, his clinical research has helped develop advanced imaging techniques that may prove to be helpful in identifying areas of the heart that experience inadequate blood flow.1,2 Canty’s basic research has defined how the heart adapts to inadequate blood flow. He found that the heart senses decreased oxygen and induces changes at the cellular level to downregulate its function and metabolism. This research demonstrated how the heart is able to protect itself from irreversible damage, providing insight into the molecular basis of a phenomenon known as hibernating myocardium, which was discovered decades ago.3,4 At first, these adaptations to low blood flow seemed entirely beneficial, but Canty came to realize that they could also have dire consequences. Using animal models of hibernating myocardium, Canty found that the regional adaptations could render the heart vulnerable to spontaneous and lethal ventricular arrhythmias.5,6 The work may help to explain why patients with chronic coronary artery disease may die suddenly as their first and only manifestation of heart disease. In a recent conversation with Circulation Research , …

Near-Peer Teaching Program for First Year Residents in Medicine

Near-Peer Teaching Program for First Year Residents in Medicine

A User's Guide to the ALiEM Emergency Medicine Match Advice Web Series.

ALiEM EM Match Advice is a web series hosted on the Academic Life in Emergency Medicine website. The intended audience includes senior medical students seeking a residency in emergency medicine (EM) and the faculty members who advise them. Each episode features a panel of three EM program directors who discuss a critical step in the residency application process. This article serves as a user’s guide to the series, including a timeline for viewing each episode, brief summaries of the panel discussions, and reflection questions for discussion between students and their faculty advisors.

Resident attendance at weekly conferences after implementation of an optional asynchronous learning curriculum.

Asynchronous learning (ASL) is a student-centered method of teaching utilizing online learning resources to overcome time and space constraints to facilitate information sharing and interaction amongst learners.1 Studies show it to be a valued and effective method of learning.2 As the availability of online educational resources for physicians has increased in recent years,3 Free Open Access Medical Education (FOAM) has become a familiar term to many. Some have suggested that ASL via FOAM can be a more flexible and cost-effective teaching method compared to conventional methods.4 In fact, FOAM may be preferred by the current generation of ‘millennial’ learners.5,6 Despite its increasing prevalence and utilization, FOAM is not a panacea. Educators who support a constructivist epistemology for education argue that the inherent isolation of ASL (studying alone at a private computer workstation) is a detriment. In addition, ASL can decrease learner satisfaction by diminishing a student’s sense of connection to peer learners.7 As such, blended learning, a hybrid combining classroom and online learning, creates a stronger sense of community amongst learners than either traditional or online courses alone.8 The Emergency Medicine (EM) Residency Review Committee (RRC) encourages programs to supplement the weekly educational conference curriculum with ASL in the form of “Individualized Interactive Instruction (III)”.9 In response, our EM residency program devised and implemented an optional, Web-based, asynchronous learning curriculum (ASYNC) to supplement our traditional planned weekly residency educational conferences, in essence creating an optional ”blended curriculum”. Consistent with RRC recommendations, we permitted residents to utilize ASYNC to obtain up to 20% of required residency educational conference attendance as extra credit (the equivalent of one hour out of the five offered each week within the extant didactic curriculum). The American College of Graduate Medical Education (ACGME)-mandated 70% conference attendance rate served as an inherent incentive to participate in ASYNC.9 There is no existing evidence to inform whether introducing an asynchronous learning curriculum will have unintended consequences such as lowering attendance to planned educational activities. Considering the current generation of ‘millennial’ learners’ preference for FOAM,5 it is conceivable that implementation of ASYNC would be associated with a reduction in attendance rates within the EM didactic curriculum. Such experiences may give educators and program directors pause before implementing an analogous curriculum. ASYNC Design and Implementation We implemented ASYNC in February 2015 at an urban, academic medical center which hosts a postgraduate year (PGY) 1-4 EM training program of 48 residents. ASYNC consists of two components, devised and supervised by residency program directors. The first portion incorporates Academic Life in Emergency Medicine’s (ALiEM) Approved Instructional Resources (AIR) series.10 Since most of the curated FOAM content from AIR comprises of high-yield evidence-based summaries of medical literature, we developed the second part of ASYNC to encourage the primary appraisal of the literature to promote self-directed assessment seeking and reflection. This second component of ASYNC consists of two monthly high-impact journal articles, selected by faculty. Learners are expected to read the articles and contribute to an online discussion board designed to encourage interaction amongst residents and faculty regarding if and how the literature can be translated into clinical practice.

Emergency Medicine Morbidity and Mortality Conference and Culture of Safety: The Resident Perspective.

Morbidity and mortality conference (M&M) is common in emergency medicine (EM) and an Accreditation Council for Graduate Medical Education (ACGME) requirement. We aimed to characterize the prevalence of elements of EM M&M conferences that foster a strong culture of safety. Emergency medicine residents at 33 programs across the United States were surveyed using questions adapted from a previously tested survey of EM program directors and the Agency for Healthcare Research and Quality (AHRQ) Culture of Safety Survey. The survey response rate was 80.3% (1,002/1,248). A total of 60.3% (601/997) of residents had not submitted a case of theirs to M&M in the past year. A total of 7.6% (73/954) reported that issues raised at M&M always led to change while 88.3% (842/954) reported that they sometimes did and 4.1% (39/954) reported that they never did. A total of 56.2% (536/954) responded that changes made due to M&M were reported back to the residents. Of residents who had cases presented at M&M, 24.2% (130/538) responded that there was regular debriefing, 65.2% (351/538) responded that there was not, and 10.6% (57/578) were unsure. A total of 10.2% (101/988) of respondents agreed that M&M was punitive, 17.4% were neutral (172/988), and 72.4% (715/988) disagreed. A total of 18.0% (178/987) of residents agreed that they felt pressure to order unnecessary tests because of M&M, 22.3% (220/987) were neutral, and 59.6% (589/987) disagreed. A total of 87.4% (862/986) felt that M&M was a valuable educational didactic session, and 78.3% (766/978) believed that M&M contributes to a culture of safety in their institution. While most residents believe that M&M is a valuable didactic session and contributes to institutional culture of safety, there are opportunities to improve by communicating changes made in response to M&M, debriefing residents who have had cases presented, and taking steps to make M&M not feel punitive to some residents.

Abstract 241: Abstract QCOR 2017

AHA QCOR 2017 Abstract submission Category: Cardiac Arrest/CPR “How well can you run a code?” Assessing resident comfort and competence with in-hospital cardiac arrest Background: Despite their frequent role in caring for patients with in-hospital cardiac arrest (IHCA), earlier data suggest residents often feel uncomfortable during resuscitations. We sought to characterize the experiences of residents at our academic institution with IHCA, delineate reasons for discomfort (if any) with their roles, and then assess what educational interventions were considered most valuable. Methods: We performed a 9-question survey that was electronically distributed to all internal medicine and medicine-pediatrics residents at the University of Michigan Health System. This survey asked residents about: 1) the number of IHCAs that residents had attended or led, 2) their comfort with their roles including leading an IHCA, 3) possible reasons for any discomfort in their roles, and 4) educational interventions that would be considered favorable. We report simple unadjusted statistics. Results: We received 100 responses from 155 residents, a 64.5% yield. Most PGY-1s and 2s reported being to few or no IHCAs (n=47/69, 68%) and that some PGY-3s and 4s had never run a resuscitation effort (n=4/31, 13%). Regardless of level of training, few residents rated their ability to run a resuscitation effort as very good or excellent (n=8, 8%). Most residents were unsatisfied with the formal education currently in place for IHCAs (ACLS training, code refresher sessions for residents on general medicine or cardiology) (n=62, 62%). The majority of residents had rarely or never given (n=72, 72%)/received feedback (n=68, 68%). Of the possible educational interventions presented as options, the most popular that were perceived among residents were debriefing with the attending physician and other residents (n=66, 66%), and debriefing in a multidisciplinary setting (n=59, 59%). Conclusion: We characterized the experience of internal medicine and medicine-pediatrics residents with leading IHCAs at our academic institution. We found few residents perceived their own comfort and competence as adequate. These findings provide a foundation for future efforts to potentially elevate resident performance in IHCA.

Abstract 173: Simple Guidance Improves Appropriate Telemetry Utilization

Introduction: Cardiac telemetry is an in-hospital monitoring tool intended for ischemia surveillance, monitor QT-interval prolongation, and detect arrhythmias. It is a costly and limited resource that is frequently misused. Inappropriate telemetry use can lead to prolonged hospital stays, patient discomfort, alarm fatigue, and increased healthcare costs. We designed and implemented a telemetry guideline independent of the electronic health record (EHR) in an attempt to increase appropriate telemetry use in non-intensive care unit (ICU) setting Objectives: To design and implement a telemetry guideline. To increase appropriate use of telemetry. To practice cost-conscious, high-value care Aim: Primary Aim: Implement a telemetry guideline using pocket cards and educational conferences and monitor telemetry assignments Secondary Aim: Assess patient outcomes as reflected by the number of codes before and after the intervention Methods: We adopted telemetry criteria based on the American Heart Association guidelines from 2004 and other published literature. Baseline data was collected in November 2015 for all medicine teaching team admissions at our institution that came through the emergency department. Exclusion criteria were ICU transfers, step-down units, and direct admissions. Guidelines were then implemented via educational conferences and pocket card distribution to ED physicians, admitting hospitalists and medicine residents. Post-intervention data was collected from February through March 2016 Results: Of 180 admissions prior to guideline implementation, 93 patients (52%) went to non-telemetry beds and 87 patients (48%) to telemetry beds. Of the telemetry admissions, 60 patients (69%) were appropriately assigned to telemetry while 27 (31%) were not. After the guideline was implemented, 255 patients were reviewed. Of these, 110 (43%) went to telemetry beds, and 86 patients (78%) were appropriately assigned while 24 patients (22%) were not. There was no significant increase or decrease in the number of codes post intervention. Cost analysis revealed 103 telemetry-bed-days saved per month Conclusion: Our intervention resulted in a large (9.1%) but statistically insignificant increase in appropriate telemetry use. Although statistically insignificant, this improvement was durable across two months. Cost analysis revealed 103 telemetry-bed-days saved per month with an estimated savings of $100,000 in unnecessary charges. The relatively simple and cost-effective intervention of creating and implementing a telemetry assignment guideline was effective in changing telemetry ordering behavior. This was done without telemetry assignment logic in the EHR, which can be a tedious and time-consuming endeavor. Future efforts will include the implementation of a telemetry auditing tool, and ultimately the embedded logic to facilitate ordering practices.

Two birds with one stone: experiences of combining clinical and research training in addiction medicine

BackgroundDespite a large evidence-base upon which to base clinical practice, most health systems have not combined the training of healthcare providers in addiction medicine and research. As such, addiction care is often lacking, or not based on evidence or best practices. We undertook a qualitative study to assess the experiences of physicians who completed a clinician-scientist training programme in addiction medicine within a hospital setting.MethodsWe interviewed physicians from the St. Paul’s Hospital Goldcorp Addiction Medicine Fellowship and learners from the hospital’s academic Addiction Medicine Consult Team in Vancouver, Canada (N = 26). They included psychiatrists, internal medicine and family medicine physicians, faculty, mentors, medical students and residents. All received both addiction medicine and research training. Drawing on Kirkpatrick’s model of evaluating training programmes, we analysed the interviews thematically using qualitative data analysis software (Nvivo 10).ResultsWe identified five themes relating to learning experience that were influential: (i) attitude, (ii) knowledge, (iii) skill, (iv) behaviour and (v) patient outcome. The presence of a supportive learning environment, flexibility in time lines, highly structured rotations, and clear guidance regarding development of research products facilitated clinician-scientist training. Competing priorities, including clinical and family responsibilities, hindered training.ConclusionsCombined training in addiction medicine and research is feasible and acceptable for current doctors and physicians in training. However, there are important barriers to overcome and improved understanding of the experience of addiction physicians in the clinician-scientist track is required to improve curricula and research productivity.

A “Marginalized Part of Adolescent Healthcare”: Emergency Contraception Training Experiences Among Residents in Pediatrics, Family and Emergency Medicine

A “Marginalized Part of Adolescent Healthcare”: Emergency Contraception Training Experiences Among Residents in Pediatrics, Family and Emergency Medicine

Introducing a Novel Applicant Ranking Tool to Predict Future Resident Performance: A Pilot Study.

The purposes of this study are to (1) introduce our novel Applicant Ranking Tool that aligns with the Accreditation Council for Graduate Medical Education competencies and (2) share our preliminary results comparing applicant rank to current performance. After a thorough literature review and multiple roundtable discussions, an Applicant Ranking Tool was created. Feasibility, satisfaction, and critiques were discussed via open feedback session. Inter-rater reliability was assessed using weighted kappa statistic (κ) and Kendall coefficient of concordance (W). Fisher's exact tests evaluated the ability of the tool to stratify performance into the top or bottom half of their class. Internal medicine and anesthesiology residents served as the pilot cohorts. The tool was considered user-friendly for both data input and analysis. Inter-rater reliability was strongest with intradisciplinary evaluation (W = 0.8-0.975). Resident performance was successfully stratified into those functioning in the upper vs. lower half of their class within the Clinical Anesthesia-3 grouping (p = 0.008). This novel Applicant Ranking Tool lends support for the use of both cognitive and noncognitive traits in predicting resident performance. While the ability of this instrument to accurately predict future resident performance will take years to answer, this pilot study suggests the instrument is worthy of ongoing investigation.

How we read FCH-PET/CT for prostate cancer

Over the last decade, 18F-fluorocholine positron emission tomography/computed tomography (FCH-PET/CT) has gained in popularity for the staging and restaging of patients with prostate cancer (PCa). However, despite abundant literature on the topic, there is a lack of publications on how to actually interpret FCH-PET/CT in a clinical setting. Here we propose a practical, TNM-oriented approach to read FCH-PET/CT, with notes on procedure technique, image display, review sequence and report structure. The purpose of this article is to provide guidance to radiologists, nuclear medicine physicians and residents who are new to FCH-PET/CT, as well as to propose an alternate approach to more experienced physicians.

Efficacy of Osteopathic Manipulative Treatment for Management of Postpartum Pain.

Pain is one of the most common postpartum complaints by women in the United States, and the pain varies in its location. Research on intervention strategies for postpartum pain has focused primarily on the lower back, but pain management for other types of postpartum pain remains unclear. To investigate the effects of osteopathic manipulative treatment (OMT) on postpartum pain; the location, quality, and timing of pain; and the difference in pain between vaginal and cesarean delivery. Postpartum patients who reported having pain were recruited at St Barnabas Hospital in Bronx, New York. The short-form McGill Pain Questionnaire was administered along with a screening questionnaire. Second- or third-year residents in neuromusculoskeletal medicine and osteopathic manipulative medicine examined patients and then diagnosed and managed somatic dysfunction with OMT for approximately 25 minutes. The short-form McGill Pain Questionnaire was again administered after OMT. Paired t tests and McNemar tests were used to analyze changes before and after OMT for continuous and categorical variables, respectively. Differences in visual analog scale (VAS) pain scores between patients who had vaginal vs cesarean delivery were tested using analysis of variance, and group differences in pain location were tested using a Pearson χ2 test. A total of 59 patients were included in the study. The mean VAS score for pain was 5.0 before OMT and 2.9 after OMT (P<.001). The VAS scores before OMT significantly differed between patients who had a vaginal delivery and those who had a cesarean delivery (P<.001), but the mean decrease in VAS score was similar in both groups. Decreases in low back pain (34 [57.6%] before and 16 [27.1%] after OMT), abdominal pain (32 [54.2%] before and 22 [37.3%] after OMT), and vaginal pain (11 [18.6%] before and 5 [8.5%] after OMT) were reported after OMT (P<.05). Preliminary results demonstrate that OMT is efficacious for postpartum pain management. The lack of a control group precludes the ability to make causal claims. Future studies are needed to solidify OMT efficacy and generalizability.