Southern Illinois University School Of Medicine Research Articles

Standardizing Patient and Provider Education to Address Breastfeeding Inequity

Introduction: Breastfeeding provides many infant, maternal and societal benefits. Breastfeeding reduces maternal and infant risks for a number of diseases, encourages maternal-infant bonding, is more environmentally friendly and lowers healthcare costs. Based on the most recent Women, Infants and Children (WIC) program data, the obstetrical patient population served by the Department of Ob/Gyn at Southern Illinois University School of Medicine (SIU-SM) was significantly lacking in breastfeeding initiation rates (~16% in 2020) when compared to the Healthy People 2020 goal for ever breastfed infants of 81.9%. We aimed to assess areas of patient care that could be improved upon when counseling our patients about breastfeeding. Purpose: Our primary goal was to evaluate current breastfeeding initiation rates and whether these improved after implementation of the standardized breastfeeding education materials that were to be provided to both healthcare professionals and patients. Methods: In partnership with the Illinois Public Health Institute (IPHI), all patients who received prenatal care at SIU-SM, Department of Ob/Gyn were offered standardized brochures that supplemented our prenatal counseling regarding breastfeeding. Nurses, residents, and other healthcare providers were also provided information on counseling patients. Breastfeeding rates were assessed in our prenatal population prior to and after implementing standardized breastfeeding educational materials (IRB# 22-133) and compared with Chi-square tests. Results: Patient demographics were as follows: 55.9% White, 31.8% Black/African American; 95.7% non-Hispanic; 93.4% utilized Medicaid services for insurance; the mean age was 26.8 ± 6.1 years of age. Baseline breastfeeding initiation rates of ever breastfed infants were significantly higher in the interventional group compared to the control group (75% vs.60%; p=0.002). Breastfeeding rates at the first postpartum visit were also significantly increased after the intervention (65% vs. 43%; p=0.008). A significant increase in the percentage of breast pumps provided in the prenatal clinic was also noted (28.4% vs. 0%; p<0.0001). Conclusions: Breastfeeding rates in our patient population were significantly lower than the Healthy People’s 2020 goal. Raising awareness through this initiative and improving our educational tools via the partnership with IPHI improved breastfeeding initiation rates. As obstetrical providers, we are optimistic about this data, but acknowledge additional interventions may be necessary to improve health equity across our disadvantaged patient population. Future directions include looking at data for ever breastfed infants vs. continuation of breastfeeding through the American Academy of Pediatrics recommended 6 months of exclusive breastfeeding. We would also like to explore how partner involvement and occupation type might impact breastfeeding initiation rates.

Pediatric population health analysis of southern and central Illinois region: A cross sectional retrospective study using association rule mining and multiple logistic regression

BackgroundSouthern Illinois University School of Medicine (SIUSOM) collects large amounts of data every day. SIUSOM and other similar healthcare systems are always looking for better ways to use the data to understand and address population level problems. The purpose of this study is to analyze the administrative dataset for pediatric patients served by Southern Illinois University School of Medicine (SIUSOM) to uncover patterns that correlate specific demographic information to diagnoses of pediatric diseases. The study uses a cross-sectional database of medical billing information for all pediatric patients served by SIUSOM between June 2013 and December 2016. The dataset consists of about 980.9K clinical visits for 65.4K unique patients and includes patient demographic identifiers such as their sex, date of birth, race, anonymous zipcode and primary and secondary insurance plan as well as the related pediatric diagnosis codes. The goal is to find unknown correlations in this database. MethodWe proposed a two step methodology to derive unknown correlations in SIUSOM administrative database. First, Class association rule mining was used as a well-established data mining method to generate hypothesis and derive associations of the form D → M, where D is diagnosis code of a pediatric disease and M is a patient demographic identifier (age,sex, anonymous zipcode, insurance plan, or race). The resulting associations were pruned and filtered using measures such as lift, odds ratio, relative risk, and confidence. The final associations were selected by a pediatric doctor based on their clinical significance. Second,each association rule in the final set was further validated and adjusted odds ratios were obtained using multiple logistic regression. ResultsSeveral associations were found correlating specific patients’ residential zip codes with the diagnosis codes for viral hepatitis carrier, exposure to communicable diseases, screening for mental and developmental disorder in childhood, history allergy to medications, disturbance of emotions specific to childhood, and acute sinusitis. In addition, the results show that African American patients are more likely to be screened for mental and developmental disorders compared to White patients for SIUSOM pediatric population (Odds Ratio (OR):3.56, 95% Confidence Interval (CI):[3.29,3.85]). ConclusionClass association rule mining is an effective method for detecting signals in a large patient administrative database and generating hypotheses which correlate patients’ demographics with diagnosis of pediatric diseases. A post processing of the hypotheses generated by this method is necessary to prune spurious associations and select a set of clinically relevant hypotheses.

The journeys of three ASPIRE winning medical schools toward excellence in student assessment

Introduction: ASPIRE Excellence Awards in Student Assessment are offered to medical schools with innovative and comprehensive assessment programmes adjudged by international experts, using evidence-based criteria.The journeys of three ASPIRE-winning medical schools toward “assessment excellence” are presented. These schools include Aga Khan University Medical College (AKU-MC), Pakistan, Southern Illinois University School of Medicine (SIUSOM), USA, and University of Leeds School of Medicine, UK.Methods: The unfolding journeys highlighting achievements, innovations, and essential components of each assessment programme were compared to identify differences and commonalities.Results: Cultural contextual differences included developed-versus-developing country, east-west, type of regulatory bodies, and institutional-versus-national certifying/licensing examinations, which influence curricula and assessments.In all, 12 essential commonalities were found: alignment with institutional vision; sustained assessment leadership; stakeholder engagement; communication between curriculum and assessment; assessment-for-learning and feedback; longitudinal student profiling of outcome achievement; assessment rigor and robustness; 360° feedback from-and-to assessment; continuous enrichment through rigorous quality assurance; societal sensitivity; influencing others; and a “wow factor.”Conclusions: Although the journeys of the three medical schools were undertaken in different cultural contexts, similar core components highlight strong foundations in student assessment. The journeys continue as assessment programmes remain dynamic and measurement science expands. This article may be helpful to other institutions pursuing excellence in assessment.

Establishing Validity Evidence for an Operative Performance Rating System for Plastic Surgery Residents

The aim of this study was to describe an operative performance rating system for plastic surgery residents and provide validity evidence for the instrument. Three plastic surgery residents (PGY levels 1, 5, and 6) from Southern Illinois University School of Medicine (SIUSOM) performed a carpal tunnel release with audio video recording. The 3 videos were reviewed by 8 expert hand surgeons and 3 SIUSOM faculty using the operative performance rating system instrument to assess resident operative performance. Validity evidence including content, internal structure, and relationship to other variables was collected. Inter-rater reliability was consistently fair to moderate (weighted Cohen's Kappa 0.44-0.84 for experts, 0.24-0.55 for SIUSOM raters), and all assessment items were highly correlated (Cronbach's alpha of 0.9867). Local SIUSOM faculty routinely demonstrated higher overall scores for PGY 1 and PGY 6 residents compared to expert raters. Although limited by small numbers, this pilot study suggests that potential bias based upon PGY year, identity, and performance history may exist and independent assessment by unbiased raters or comparison to national operative norms may be valuable. Our study provides baseline validity evidence for a resident operative performance assessment tool that can be integrated into practice in plastic surgery training programs.

ASPIRE-ing to Excellence at SIUSOM.

This article was migrated. The article was marked as recommended. This Personal View article describes the experience of Southern Illinois University School of Medicine (SIUSOM) with the AMEE School Programme for International Recognition of Excellence in Education (ASPIRE) awards program. Institutional leaders considering applying may need something more than the program description to take the plunge. We use narrative to present our reasons for applying, how the application and review process went for us, and the benefits of getting involved. By sharing our story, we hope to motivate other educators who believe in their school's educational excellence to visualize themselves as applicants and take action.

Abstract A83: Development of a New Inter-Institutional Partnership to Assess Health Literacy Disparities in the Context of Kidney Cancer and Smoking

Abstract Background: Kidney cancer mortality rates are significantly higher among individuals diagnosed with later-stage disease, but there are currently no efficacious methods for kidney cancer screening. As a result, primary prevention via reduction of modifiable risk factors such as smoking, as well prompt diagnosis following early symptoms of the disease, are key to reducing kidney cancer mortality. Recent research conducted at Southern Illinois University School of Medicine (SIUSOM) has found that rural residents of Southern and Central Illinois have some of the highest kidney cancer incidence and mortality rates in the nation. However, this disparity is not fully explained by the limited number of urologists practicing within this region. Higher rates of smoking, higher thresholds for medical help-seeking behavior, and/or lower levels of health literacy may contribute to the increased incidence and mortality rates within this population, but urban-rural differences in these factors have not be examined within the region. Partnership Development: To address these critical research gaps, SIUSOM investigators with expertise in urology and clinical trial implementation developed a pilot research project with Washington University in St. Louis (WUSTL) investigators specializing in health behavior and health disparities research. The pilot project was submitted as part of an NCI-funded P20 center exploring the feasibility of building a collaborative partnership between Simmons Cancer Institute at SIUSOM and WUSTL's Siteman Cancer Center. Research Objectives: The goals of the pilot project are to assess potential geographic differences (urban vs. rural) in: 1) health literacy and cancer literacy; 2) knowledge of smoking as a kidney cancer risk factor; and 3) degree of bother caused by general urologic symptoms. During the development and implementation of the pilot project, the research team is also monitoring the progress and barriers in building new collaborative partnerships that span two institutions located approximately 100 miles apart. Research Methods: The pilot project is currently enrolling a total of 300 individuals attending primary care or urology clinic appointments in Springfield, IL (n=60); Carbondale, IL (n=120); and St. Louis, MO (n=120). Because the pilot project is designed to assess regional variation in relevant risk factors rather than the relationship between risk factors and kidney cancer development, all clinic patients must be at least 40 years old and must not have a personal history of kidney cancer. Individuals who consent to participate in the study complete a self-administered survey via Android tablet while waiting for their clinic appointment. Interim Findings: During the pilot project development and implementation phases, we have leveraged existing institutional resources, such as the Research Electronic Data Capture (REDCap) system, to streamline our data collection and management across multiple locations. However, we have encountered some challenges in establishing uniform practices for clinic-based recruitment and enrollment, given the unique clinic organization and patient flow issues in each geographic location. Recruitment and enrollment are currently underway, and preliminary quantitative results will be available by mid-September. Citation Format: Erin Linnenbringer, Shaheen Alanee, Katina Richardson, Nirek Sharma, Aimee James, Danuta Dynda, Kevin McVary. Development of a New Inter-Institutional Partnership to Assess Health Literacy Disparities in the Context of Kidney Cancer and Smoking. [abstract]. In: Proceedings of the Ninth AACR Conference on the Science of Cancer Health Disparities in Racial/Ethnic Minorities and the Medically Underserved; 2016 Sep 25-28; Fort Lauderdale, FL. Philadelphia (PA): AACR; Cancer Epidemiol Biomarkers Prev 2017;26(2 Suppl):Abstract nr A83.

Delivering a medical school elective with massive open online course (MOOC) technology

Introduction: The educational technology of massive open online courses (MOOCs) has been successfully applied in a wide variety of disciplines and are an intense focus of educational research at this time. Educators are now looking to MOOC technology as a means to improve professional medical education, but very little is known about how medical MOOCs compare with traditional content delivery.Methods: A retrospective analysis of the course evaluations for the Medicine as a Business elective by fourth-year medical students at Southern Illinois University School of Medicine (SIU-SOM) for the 2012–2015 academic years was conducted. This course was delivered by small group flipped classroom discussions for 2012–2014 and delivered via MOOC technology in 2015. Learner ratings were compared between the two course delivery methods using routinely collected course evaluations.Results: Course enrollment has ranged from 6–19 students per year in the 2012–2015 academic years. Student evaluations of the course are favorable in the areas of effective teaching, accurate course objectives, meeting personal learning objectives, recommending the course to other students, and overall when rated on a 5-point Likert scale. The majority of all student ratings (76–95%) of this elective course are for the highest possible choice (Strongly agree or Excellent) for any criteria, regardless if the course was delivered via a traditional or MOOC format. Statistical analysis of these ratings suggests that the Effective Teacher and Overall Evaluations did not statistically differ between the two delivery formats.Discussion: Student ratings of this elective course were highly similar when delivered in a flipped classroom format or by using MOOC technology. The primary advantage of this new course format is flexibility of time and place for learners, allowing them to complete the course objectives when convenient for them. The course evaluations suggest this is a change that is acceptable to the target audience.Conclusions: This study suggests that learner evaluations of a fourth-year medical school elective course do not significantly differ when delivered by flipped classroom group discussions or via MOOC technology in a very small single center observational study. Further investigation is required to determine if this delivery method is an acceptable and effective means of teaching in the medical school environment.

Spectrum of tablet computer use by medical students and residents at an academic medical center.

Introduction. The value of tablet computer use in medical education is an area of considerable interest, with preliminary investigations showing that the majority of medical trainees feel that tablet computers added value to the curriculum. This study investigated potential differences in tablet computer use between medical students and resident physicians.Materials & Methods. Data collection for this survey was accomplished with an anonymous online questionnaire shared with the medical students and residents at Southern Illinois University School of Medicine (SIU-SOM) in July and August of 2012.Results. There were 76 medical student responses (26% response rate) and 66 resident/fellow responses to this survey (21% response rate). Residents/fellows were more likely to use tablet computers several times daily than medical students (32% vs. 20%, p = 0.035). The most common reported uses were for accessing medical reference applications (46%), e-Books (45%), and board study (32%). Residents were more likely than students to use a tablet computer to access an electronic medical record (41% vs. 21%, p = 0.010), review radiology images (27% vs. 12%, p = 0.019), and enter patient care orders (26% vs. 3%, p < 0.001).Discussion. This study shows a high prevalence and frequency of tablet computer use among physicians in training at this academic medical center. Most residents and students use tablet computers to access medical references, e-Books, and to study for board exams. Residents were more likely to use tablet computers to complete clinical tasks.Conclusions. Tablet computer use among medical students and resident physicians was common in this survey. All learners used tablet computers for point of care references and board study. Resident physicians were more likely to use tablet computers to access the EMR, enter patient care orders, and review radiology studies. This difference is likely due to the differing educational and professional demands placed on resident physicians. Further study is needed better understand how tablet computers and other mobile devices may assist in medical education and patient care.

Delivering kidney cancer care in rural Central and Southern Illinois: a telemedicine approach.

There is a growing body of experience and research suggesting that telemedicine (video conferencing, smart phones and online patient portals) could be the solution to addressing gaps in the provision of specialised healthcare in rural areas. The proposed role of telemedicine in providing needed services in hard to reach areas is not new. The United States Telecommunication Act of 1996 provided the initial traction for telemedicine by removing important economic and legal obstacles regarding the use of technology in healthcare delivery. This initial ruling has been supplemented by the availability of federal funding to support efforts aimed at developing telemedicine in underserved areas. In this paper, we explore one aspect of disease disparity pertinent to rural Illinois (kidney cancer incidence and mortality) and describe how we are planning to use an existing telemedicine program at Southern Illinois University School of Medicine (SIUSOM) to improve kidney cancer (Kca) care in rural Illinois. This represents an example of the possible role of telemedicine in addressing healthcare disparities in rural areas/communities and provides a description of general challenges and barriers to the implementation and maintenance of such systems.

Medical students’ online learning technology needs

This study investigated medical students' online learning technology needs at a medical school. The study aimed to provide evidence-based guidance for technology selection and online learning design in medical education. The authors developed a 120-item survey in collaboration with the New Technology in Medical Education (NTIME) committee at the Southern Illinois University School of Medicine (SIUSOM). Overall, 123 of 290 medical students (42%) at the medical school participated in the survey. The survey focused on five major areas: students' hardware and software use; perception of educational technology (ET) in general; online behaviours; perception of ET use at the school; and demographic information. Students perceived multimedia tools, scheduling tools, communication tools, collaborative authoring tools, learning management systems and electronic health records useful educational technologies for their learning. They did not consider social networking tools useful for their learning, despite their frequent use. Third-year students were less satisfied with current technology integration in the curriculum, information sharing and collaborative learning than other years. Students in clerkships perceived mobile devices as useful for their learning. Students using a mobile device (i.e. a smartphone) go online, text message, visit social networking sites and are online during classes more frequently than non-users. Medical students' ET needs differ between preclinical and clinical years. Technology supporting ubiquitous mobile learning and health information technology (HIT) systems at hospitals and out-patient clinics can be integrated into clerkship curricula.

Cetuximab in Refractory Skin Cancer Treatment

Objectives: Non-melanoma skin cancer is the most common malignancy in US, with an annual incidence of in excess of 1.5 million cases. In the majority of cases, locoregional treatment is curative and systemic therapy is not indicated. Platinum-based chemotherapy regimens have been used most commonly in refractory cases. The use of cetuximab, a monoclonal antibody targeting epidermal growth factor receptor [EGFR], has been reported for skin cancer treatment. This current study evaluated eight cases of locally advanced and refractory basal cell or squamous cell cancers which were treated with cetuximab.Methods: This is a retrospective study on eight patients who had received cetuximab for treatment of cutaneous carcinoma since 2007 at Southern Illinois University School of Medicine (SIU-SOM) Medical Oncology clinic.Results: Three of the four patients with basal cell carcinoma and two of the four patients with squamous cell carcinoma maintained remission on treatment.. The main side effect was acneiform rash which required termination of treatment for one patient and dose reduction in another.Conclusion: The study indicates that cetuximab may have a beneficial role for patients with non-melanoma cutaneous carcinomas that are refractory to standard therapy.

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Southern Illinois University-School of Medicine Harvard Medical School Massachusetts General Hospital Correspondence to Dr. Wilhelmi Southern Illinois University-School of Medicine P.O. Box 19653 Springfield, Ill. 62794-9653[email protected]

Teaching pharmacology within a multidisciplinary organ system-based medical curriculum.

We have described how the pharmacology of agents that act on the central nervous system (CNS) and endocrine system were incorporated into a case-based, multidisciplinary, integrated sophomore medical curriculum at Southern Illinois University School of Medicine (SIUSM). Faculty members from the Departments of Pharmacology, Pathology, Internal Medicine, Psychiatry, and Neurology were major participants in the CNS block, and faculty with primary expertise in radiology, epidemiology, and immunology also participated. Integrated sessions involving the entire class were organized around brief patient cases, which were given to the students in advance of the session. During the sessions, each patient case was presented by a physician or pathologist who briefly described symptoms, history, physical findings, differential diagnosis, and the classification of the subtypes of the particular class of disorder. The pathophysiology of the disease was discussed, and the pharmacology of agents to be considered for therapy was presented in the context of the Pharmacology Mental Algorithm, a systematic and rational approach to drug therapy. The session was completed by a clinician who added further clinically relevant information, which was followed by a question-and-answer period involving all faculty participants. The CNS block was presented over a 1-month period and included standardized patients and real patients who consistently exhibited specific disease findings, and these patient-oriented sessions were followed with small group tutorial sessions. Single discipline large-group sessions were also used to present material that is introductory or unique to a particular discipline. Student knowledge was assessed, using integrated evaluations based on case vignettes with multiple-choice questions provided by each discipline. The goal of the examination was to evaluate knowledge base in the discipline areas and its application to clinical problem-solving. A practical evaluation of each student's patient examination skills in CNS was also performed by clinicians. Feedback from the students on the organ system activities was obtained using a questionnaire. Development of these sessions required leadership and a considerable amount of time to organize, improve, and update sessions. The integrated approach largely eliminated the use of conflicting terminology and redundancy of material common with separate presentations on the same subject by different disciplines. The multidisciplinary, case-based sessions were perceived to be instructive, valuable learning experiences, based on formal and informal student and faculty feedback.

ENDOCRINE PBL IN THE YEAR 2000

The Southern Illinois University School of Medicine (SIU-SOM) has utilized problem-based learning (PBL) in its curriculum since 1981, when Dr. Howard Barrows joined the faculty. From 1989 to 2000, SIU-SOM implemented two parallel curricula for the basic science years (years I and II), one curriculum being a problem-based learning curriculum (PBLC). An executive decision to design and implement a single curriculum, to begin in Fall 2000, fostered a review of existing pedagogy upon which to base this new curriculum: C2000. The results of this review, which considered formal outcome measures as well as internal review in consideration of the institutional mission, led to PBL becoming the predominant pedagogy for C2000, albeit with some modifications from its PBLC predecessor. C2000, then, represents the third iteration of PBL in use at SIU-SOM, and its design and rationale offer insight for the teaching of Endocrine Physiology in a PBLC.

Feasibility of problem-based learning in Jiujiang Medical College: why not try it?

Against a background of problems in delivering rural health care in the Jiujiang district of China, this paper outlines the development of a relevant 3-year SSO (Strengthening the training of clinical skills, Strengthening preventive medicine education, and Optimizing curricular structure) programme at Jiujiang Medical College (JMC). Some comparisons between JMC and the Southern Illinois University School of Medicine (SIUSM) are made, and the possibility of applying problem-based learning to JMC is discussed.