University Of Minnesota Medical School Research Articles

Assessments from the first year of an underrepresented undergraduate internship program

To enhance our service to a diverse student population our faculty created the INtegrative biology and Physiology Undergraduate Training (INPUT) program. This research focused initiative solicited applications from first- and second-year students undergraduates of our large, urban, land-grant university. Selection criteria included academic aptitude, self-reported socioeconomic and cultural challenges, interest in physiological research and letters of support. Six students were selected from our initial cadre of applicants. The students were matched with faculty research mentors and provided a paid research opportunity for the spring semester of 2023. At the end of the term, an assessment of the experience by both each student and mentor determined whether a second semester experience was offered by the department. All of our faculty mentors were favorably impressed by the progress made by their INPUT scholars and five of the six students requested and were granted a second semester research opportunity. The five INPUT students continued their mentored research in the areas of neurophysiology, skeletal muscle physiology, and adipose biology. The one outlier stated that while she enjoyed the experience and that it encouraged her to continue in research. She also found that her scientific passion was in chemistry rather than physiology and moved to a different program. Based on the overall positive outcomes a second semester opportunity was offered to the five students who expressed an interest in continuing their physiology-focused projects. The second term experiences were completed either during the summer or fall of 2023. We will encourage our initial group of INPUT scholars to serve as ambassadors for other underrepresented students who are interested in physiology research and use their end of experience assessments to help shape the future of our INPUT program. We will report on the opportunities discovered and the challenges faced in launching the INPUT program as well as the prospects for continued outreach. Our hope is that our experiences with INPUT will encourage others to attract, encourage and prepare a robust and representative group of young scientists and clinicians to enter the 21st century biomedical community. Department of Integrative Biology and Physiology, University of Minnesota Medical School, Minneapolis, MN 55455. This is the full abstract presented at the American Physiology Summit 2024 meeting and is only available in HTML format. There are no additional versions or additional content available for this abstract. Physiology was not involved in the peer review process.

FRI008 Impact Of Sleep Fragmentation And Estradiol Suppression On Leptin, Ghrelin, Satiety And Hunger In Women: An Experimental Menopause Model To Understand Menopause-related Body Fat Gain

Abstract Disclosure: S.A. Rahman: Consulting Fee; Self; Sultan & Knight Limited, Bambu Vault LLC, Lucidity Lighting Inc. Grant Recipient; Self; Seoul Semiconductor Co. Ltd, Biological Innovation and Optimization Systems, LLC, Merck & Co, Inc, Pfizer Inc, Vanda Pharmaceuticals Inc, Lighting Science Group. Speaker; Self; Starry Skies Lake Superior, University of Minnesota Medical School, PennWell Corp, and Seoul Semiconductor Co. Ltd. Stock Owner; Self; Melcort Inc. L.K. Grant: None. A. Cohn: None. M.D. Nathan: None. J. Harder: Consulting Fee; Self; Atman Health; O’Rourke & Hawk, LLP. Grant Recipient; Self; Brigham and Women’s Hospital; President and Fellows of Harvard College. Owner/Co-Owner; Self; Jessica Harder, MD. Stock Owner; Self; Atman Health. Other; Self; Centerfield Media Holding Company. I. Gonsalvez: None. F.A. Scheer: Consulting Fee; Self; University of Alabama at Birmingham. Other; Self; Board of Directors for the Sleep Research Society. E.B. Klerman: Consulting Fee; Self; Circadian Therapeutics, The National Sleep Foundation, Sanofi-Genzynel. Other; Self; Travel support from the Sleep Research Society. S. Crawford: None. T. Luo: None. E. Menezes: None. A. Roy: None. A. Joseph: None. A. Wiley: None. U.B. Kaiser: None. H. Joffe: Consulting Fee; Self; Bayer, Hello Therapeutics. Grant Recipient; Self; National Institutes of Health, Merck, Pfizer. Body fat increases during the menopause transition. In addition to menopause-related estradiol (E2) decline, sleep fragmentation (wake episodes interrupting sleep) due to hot flashes, without a reduction in total sleep time, is common. We examined whether E2 decline and sleep fragmentation decrease the satiety hormone, leptin, increase the orexigenic hormone, ghrelin, and their behavioral correlates satiety and hunger, which would promote positive energy balance and body fat gain. We studied 38 healthy premenopausal female volunteers (mean age [±SD] 29.7±6.7 years) in a 5-night inpatient study under eucaloric conditions, once in the mid-to-late follicular phase (high-E2) and again after gonadotropin-releasing hormone agonist-induced E2-suppression (hypo-E2) in a subset (n=27). Each inpatient study involved 2 nights of unfragmented sleep followed by 3 nights of experimentally induced sleep fragmentation to achieve ∼1hr of wake after sleep-onset without reducing total sleep time. Serum for leptin and acetylated ghrelin assays and self-reported satiety and hunger via visual analog scales were collected fasting ∼1hr after waking each morning. Values were normalized relative to each individual’s baseline (high-E2, unfragmented sleep) and then compared between conditions using generalized linear mixed models. Mean (±SD) levels of leptin and ghrelin at baseline were 38.5±21.2 ng/mL and 640.9±362.0 pg/mL, respectively. Compared to the high-E2 state, omnibus analysis of E2 suppression during both unfragmented and fragmented sleep showed significant reduction from the high-E2 to hypo-E2 state in satiety-promoting leptin levels (least squares mean % of baseline [±SE]: 101.0±1.1% vs. 90.0±3.0%, p=0.001), but unchanged self-rated satiety (109.3±7.8% vs. 102.6±15.6%, p=0.58). E2 suppression also did not change hunger-promoting ghrelin levels (101.0±3.1% vs. 97.0±1.4%, p=0.13) or self-rated hunger (103.3±6.6% vs. 133.2±30.5%, p=0.28). Omnibus analysis of sleep fragmentation during both high-E2 and hypo-E2 states showed that, relative to unfragmented sleep, leptin levels were unchanged (94.0±1.5% vs. 96.7±2.5%, p=0.22), but self-rated satiety was significantly lower (113.1±11.0% vs. 99.2±11.9%, p=0.048) after sleep fragmentation. There was a trend towards the lowest satiety in the hypo-E2 sleep fragmented state (interaction p=0.052). Sleep fragmentation did not change ghrelin levels (100.7±1.8% vs. 97.3±2.7%, p=0.13) or self-rated hunger (103.0±6.2% vs. 133.6±30.0%, p=0.25). These results demonstrate significant adverse changes in leptin and satiety in women induced, respectively, by E2 suppression and sleep fragmentation, independent of aging. Findings support likely independent contributions of E2 decline and sleep fragmentation during the menopause transition toward positive energy balance and body fat gain. Funding: NIH R01AG053838 (PI: H Joffe). Presentation: Friday, June 16, 2023

FRI411 Pharmacologically Induced Hypoestrogenism And Experimentally Induced Menopause-Pattern Sleep Fragmentation Independently Influence Circulating Lipids, Heart Rate, And Blood Pressure In Women

Abstract Disclosure: L.K. Grant: Grant Recipient; Self; Brigham and Women’s Hospital, Women’s Health Access Matters. A. Cohn: None. S. Crawford: None. J. Harder: Consulting Fee; Self; Altman Health, O’Rouke & Hawk, LLP. Grant Recipient; Self; Brigham and Women’s Hospital, President and Fellows of Harvard College. Owner/Co-Owner; Self; Jessica Harder, MD. Stock Owner; Self; Altman Health. Other; Self; Centerfield Media Holding Company. M.D. Nathan: None. I. Gonsalvez: None. T. Luo: None. E. Menezes: None. A. Roy: None. A. Wiley: None. F.A. Scheer: Consulting Fee; Self; University of Alabama. Other; Self; Board of Directors for the Sleep Research Society. E. Klerman: Consulting Fee; Self; American Academy of Sleep Medicine Foundation, Sleep Research Society Foundation, Circadian Therapeutics, National Sleep Foundation, Yale University Press. U.B. Kaiser: None. S. Mora: Consulting Fee; Self; Pfizer, Inc. J. Taylor: None. H. Joffe: Consulting Fee; Self; Bayer, Inc., Hello Therapeutics. Grant Recipient; Self; Merck, Pfizer, Inc., NIH. S.A. Rahman: Consulting Fee; Self; Sultan & Knight Limited, Bambu Vault LLC, Lucidity Lighting Inc. Grant Recipient; Self; Seoul Semiconductor Co. Ltd, Biological Innovation and Optimization Systems, LLC, Pfizer, Inc., Merck & Co., Lighting Science Group. Speaker; Self; Starry Skies Lake Superior, University of Minnesota Medical School, PennWell Corp, Seoul Semiconductor Co. Ltd. Stock Owner; Self; Melcort Inc. Introduction: The risk of cardiovascular disease (CVD) in women increases at menopause. Although declining levels of estradiol (E2) have been implicated in the increase in CVD risk for midlife women, it remains difficult to isolate these effects from the parallel changes in chronological age, and other potential contributing, mediating and modifying factors such as menopause-pattern sleep fragmentation (increased awakenings but no change in overall sleep duration). Here, we investigated whether hypo-estrogenism (hypo-E2) and sleep fragmentation increase CVD risk factors [lipids, blood pressure (BP)] in an experimental menopause model implemented in premenopausal women. Method: Two 5-night inpatient studies performed in the mid-to-late follicular phase (E2 = 48.7±29.5 pg/mL) and repeated following leuprolide-induced hypo-E2 (E2 = 7.5±5.9 pg/mL) were completed in 27 premenopausal women (mean age = 28.4±5.6 years). Each admission involved 2 nights of unfragmented sleep [8-h time-in-bed (TIB)] followed by 3 nights of sleep fragmentation, induced by auditory stimuli distributed across the night, producing 1-hr of cumulative wakefulness while enabling equal sleep opportunity (9-h TIB). BP and heart rate (HR) measurements were collected within 1 hour of wake in a semi-supine position each morning; fasting serum lipids were collected during unfragmented sleep and again after 3 nights of sleep fragmentation, during both inpatient stays. The effect of sleep fragmentation, E2 state and their interaction were assessed using generalized linear models to account for repeated measures. Results: Relative to the estrogenized state, the hypo-E2 state had a significant increase in total cholesterol (156±5 vs. 167±6 mg/dL, p<.001), triglycerides (72±5 vs 79±7 mg/dL, p<.001), HDL-C (58±3 vs. 62±3 mg/dL, p<.01), LDL-C (81±4 vs. 86±5 mg/dL, p<.05) and mean arterial pressure (MAP; 79±1 vs. 81±1 mmHg, p<.05) and a trend toward increased diastolic BP (63±1 vs. 65±1 mmHg, p=.07), with a significant compensatory decrease in HR (67±2 vs. 65±2 bpm, p<.001). Compared to the unfragmented sleep condition, sleep fragmentation resulted in a significant increase in HR (64±2 vs. 68±2 bpm, p<.001) and a trend toward increased systolic BP (109±1 vs. 110±1 mmHg, p=.08). There was no effect of sleep fragmentation on lipid levels, diastolic BP, or MAP, and no interaction between sleep fragmentation and E2 for any of the variables. Conclusion: These experimental findings show that pharmacologically induced hypo-E2, but not sleep fragmentation, increase circulating lipids levels in pre-menopausal women. Additionally, pharmacological E2-suppression increased BP and decreased HR, whereas sleep fragmentation increased both BP and HR. Together, these findings suggest that both E2 decline, and sleep fragmentation may uniquely contribute to the increase in CVD risk during the menopause transition. Presentation: Friday, June 16, 2023

Differences in Trainee Evaluations of Faculty by Rater and Ratee Gender.

To examine whether gender differences exist in medical trainees' (residents' and fellows') evaluations of faculty at a number of clinical departments. The authors conducted a single-institution (University of Minnesota Medical School) retrospective cohort analysis of 5,071 trainee evaluations of 447 faculty (for which trainee and faculty gender information was available) completed between July 1, 2019, and June 30, 2022. The authors developed and employed a 17-item measure of clinical teaching effectiveness, with 4 dimensions: overall teaching effectiveness, role modeling, facilitating knowledge acquisition, and teaching procedures. Using both between- and within-subject samples, they conducted analyses to examine gender differences among the trainees making ratings (rater effects), the faculty receiving ratings (ratee effects), and whether faculty ratings differed by trainee gender (interaction effects). There was a statistically significant rater effect for the overall teaching effectiveness and facilitating knowledge acquisition dimensions (B = -0.28 and -0.14, 95% CI: [-0.35, -0.21] and [-0.20, -0.09], respectively, P < .001, medium corrected effect sizes between -0.34 and -0.54); female trainees rated male and female faculty lower than male trainees on both dimensions. There also was a statistically significant ratee effect for the overall teaching effectiveness and role modeling dimensions (B = -0.09 and -0.08, 95% CI: [-0.16, -0.02] and [-0.13, -0.04], P = .01 and < .001, respectively, small to medium corrected effect sizes between -0.16 and -0.44); female faculty were rated lower than male faculty on both dimensions. There was not a statistically significant interaction effect. Female trainees rated faculty lower than male trainees and female faculty were rated lower than male faculty on 2 teaching dimensions each. The authors encourage researchers to continue to examine the reasons for the evaluation differences observed and how implicit bias interventions might help to address them.

Editorial introductions.

Editorial introductions.

Development and Implementation of Video-Recorded Simulation Scenarios to Facilitate Case-Based Learning Discussions for Medical Students' Virtual Anesthesiology Clerkship.

The COVID-19 pandemic presented unique challenges to medical student education. Medical student activities involving direct patient contact were limited, challenging anesthesiology programs to develop innovative means of presenting a clinical experience to trainees. In response, the Department of Anesthesiology at the University of Minnesota Medical School quickly transitioned its introductory anesthesiology clerkship to be entirely virtual. We designed the resulting curriculum to provide medical students with the most experiential learning experience possible. We created and conducted a virtual curriculum for medical students that incorporated video-recorded simulation-based scenarios to facilitate case-based learning discussions (CBLDs). At the end of their 2-week rotation, students completed a postclerkship survey with Likert-scale questions and an open-ended question intended to elicit feedback and evaluate the efficacy of the virtual curriculum. Twenty-eight medical students finished the 2-week virtual anesthesiology clerkship over eight blocks, with all 28 students completing the postclerkship survey. Survey responses demonstrated that the virtual clerkship met or exceeded expectations in all areas. A majority of students (74%, 14 of the 19 who answered the associated question) felt that the faculty-led CBLD exercises were informative. All 28 students agreed or strongly agreed that the virtual assignments were valuable and facilitated learning. We successfully implemented a virtual anesthesiology clerkship curriculum in response to constraints presented by the COVID-19 pandemic. The virtual format provides trainees with a simulated clinical experience that can be utilized not only during future pandemics but also in modern training curricula.

Assessment Tools for Dyspnea and Respiratory Distress at the End of Life #453.

Journal of Palliative MedicineVol. 26, No. 4 Fast Facts and ConceptsAssessment Tools for Dyspnea and Respiratory Distress at the End of Life #453Mary Casey Murphy and Jacquelyn SimonisMary Casey MurphyAddress correspondence to: Mary Casey Murphy, MD, Huntsman Cancer Institute, University of Utah Health, 50 North Medical Drive, Salt Lake City, UT 84132, USA E-mail Address: mary.murphy@hci.utah.eduFast Facts and Concepts are edited by Sean Marks, MD (Medical College of Wisconsin), and Associate Editor Drew A. Rosielle, MD (University of Minnesota Medical School), with the generous support of a volunteer peer-review editorial board, and are made available online by the Palliative Care Network of Wisconsin (PCNOW); the authors of each individual Fast Fact are solely responsible for that Fast Fact's content. The full set of Fast Facts is available at PCNOW with contact information, and how to reference Fast Facts.Search for more papers by this author and Jacquelyn SimonisFast Facts and Concepts are edited by Sean Marks, MD (Medical College of Wisconsin), and Associate Editor Drew A. Rosielle, MD (University of Minnesota Medical School), with the generous support of a volunteer peer-review editorial board, and are made available online by the Palliative Care Network of Wisconsin (PCNOW); the authors of each individual Fast Fact are solely responsible for that Fast Fact's content. The full set of Fast Facts is available at PCNOW with contact information, and how to reference Fast Facts.Search for more papers by this authorPublished Online:31 Mar 2023https://doi.org/10.1089/jpm.2022.0558AboutSectionsView articleView Full TextPDF/EPUB Permissions & CitationsPermissionsDownload CitationsTrack CitationsAdd to favorites Back To Publication ShareShare onFacebookTwitterLinked InRedditEmail View article"Assessment Tools for Dyspnea and Respiratory Distress at the End of Life #453." Journal of Palliative Medicine, 26(4), pp. 582–583FiguresReferencesRelatedDetails Volume 26Issue 4Apr 2023 InformationCopyright 2023, Mary Ann Liebert, Inc., publishersTo cite this article:Mary Casey Murphy and Jacquelyn Simonis.Assessment Tools for Dyspnea and Respiratory Distress at the End of Life #453.Journal of Palliative Medicine.Apr 2023.582-583.http://doi.org/10.1089/jpm.2022.0558Published in Volume: 26 Issue 4: March 31, 2023PDF download

Annals Graphic Medicine - Advocating for Diastole

Web ExclusivesApril 2023Annals Graphic Medicine - Advocating for DiastoleFREEAnkit Mehta, MD and Tseganesh Selameab, MDAnkit Mehta, MDMinneapolis, Minnesota (A.M.)Search for more papers by this author and Tseganesh Selameab, MDSt. Paul, Minnesota (T.S.)Search for more papers by this authorAuthor, Article, and Disclosure Informationhttps://doi.org/10.7326/G22-0035 SectionsAboutVisual AbstractPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissions ShareFacebookTwitterLinkedInRedditEmail Download figure Download PowerPoint Download figure Download PowerPoint Download figure Download PowerPoint Download figure Download PowerPoint Download figure Download PowerPoint Download figure Download PowerPoint Download figure Download PowerPoint Download figure Download PowerPoint Download figure Download PowerPoint Download figure Download PowerPoint Comments0 CommentsSign In to Submit A Comment Author, Article, and Disclosure InformationAuthors: Ankit Mehta, MD; Tseganesh Selameab, MDAffiliations: Minneapolis, Minnesota (A.M.)St. Paul, Minnesota (T.S.)Acknowledgment: This work was presented in part in: Selameab T, Mehta A, Clark C. Advocating diastole [video]. From: “Speaking of Race.” Art + Medicine. TPT-Twin Cities PBS and the Center for the Art of Medicine at the University of Minnesota Medical School. 29 April 2022. Available at https://video.tpt.org/video/advocating-diastole-hhbapt/ (accessed 22 September 2022).Disclosures: The authors have reported no disclosures of interest. The forms can be viewed at www.acponline.org/authors/icmje/ConflictOfInterestForms.do?msNum=G22-0035.Author/Illustrator Information: Ankit Mehta, MD, is an illustrator, a graphic medicine enthusiast, a hospitalist with HealthPartners, and an Assistant Professor at the University of Minnesota Medical School (e-mail, [email protected]com). Tseganesh Selameab, MD, is an Assistant Professor at the University of Minnesota Medical School (e-mail, [email protected]com).This article was published at Annals.org on 28 March 2023. PreviousarticleNextarticle Advertisement FiguresReferencesRelatedDetails Metrics Current IssueApril 2023Volume 176, Issue 4 ePublished: 28 March 2023 Issue Published: April 2023 Copyright & PermissionsCopyright © 2023 by American College of Physicians. All Rights Reserved.PDF downloadLoading ...

In Memoriam: Richard H. Grimm, Jr, MD, MPH, PhD (August 22, 1946-September 8, 2022).

In Memoriam: Richard H. Grimm, Jr, MD, MPH, PhD (August 22, 1946-September 8, 2022).

What is the risk of extrapyramidal symptoms in patients taking aripiprazole?

University of Minnesota Medical School, Minneapolis, MN The corresponding author is David Power; [email protected]. The authors declare no conflict of interest.

The Effect of Pass/Fail Exam Grading on Exam Performance in a Pediatric Clerkship.

Clerkship grades are a component of determining a residency candidate's competitiveness. In 2017, the University of Minnesota Medical School's pediatric clerkship transitioned its standardized multiple-choice exam, the Aquifer Pediatrics Examination, to pass/fail with eligibility for honors being determined by clinical performance, not exam performance. We assessed the effect this change had on Aquifer exam performance and evaluated for correlation between Aquifer exam performance and clinical evaluation scores in order to gather insight into the validity of each type of assessment with respect to one another. We analyzed de-identified data from 750 medical students between the academic years of 2016 to 2017 and 2019 to 2020. Individual Aquifer exam scores were compared to individual clinical performance scores. Differences in exam performance before and after the transition to pass/fail were investigated with a two-sample t-test and Cohen's d for effect size. No correlation was found between Aquifer exam scores and clinical performance scores. The mean Aquifer exam score prior to the transition to pass/fail was 80.02 ± 7.51 while the mean after the exam was made pass/fail was 77.8 ± 7.42. This difference was statistically significant (P < .001) with a Cohen's d (effect size) of 0.297. A lack of correlation between the Aquifer exam scores and clinical performance scores was found. There was a small yet statistically significant decrease in Aquifer exam scores after the change to pass/fail; it is not clear if this represents a meaningful decrease in learning by students.

Wearables as an Aid to Cardiovascular Diagnosis in a Young Runner.

1Department of Family Medicine and Community Health, University of Minnesota Medical School, Minneapolis, MN 2Division of Cardiology, University of Texas Southwestern Medical Center, Dallas, TX Address for correspondence: William O. Roberts, MD, MS, FACSM, MHealth Fairview Phalen Village Clinic, 1414 Maryland Avenue East, St. Paul, MN 55106; E-mail: [email protected].

Catch-22, A Novel.

1A.E. Jacobs is a medical student, University of Minnesota Medical School, Minneapolis, Minnesota. 2Z.M. Linneman is a medical student, University of Minnesota Medical School, Minneapolis, Minnesota; email: [email protected]. Acknowledgements: The authors thank Dr. Jon Swanson at Washington University in St. Louis for his lecture on penicillin and Dr. Ankit Mehta at the University of Minnesota for his thoughtful notes.

Gender Distribution of Authors of Evaluation Letters for Promotion at One Medical School.

Women remain underrepresented in key leadership positions and advanced ranks in academic medicine. This study examines the numbers of men and women letter writers for promotion candidates during a 5-year period across departments, tracks, ranks, and candidate gender. A descriptive study characterized the gender of evaluation letter writers for candidates for promotion to associate or full professor at the University of Minnesota Medical School between 2015 and 2020. Letter writer and candidate gender were characterized by self-identified pronouns in the faculty biography or dossier. Letter writer gender was described by candidate department, promotion track, rank, terminal degree, and gender. Among 299 candidates for promotion, 172 (58%) were men and 127 (42%) were women; dossiers included 3,995 evaluation letters. Across all years, men wrote more letters than women (external letters, range, 69% in 2019-2020 to 75% in 2015-2016; internal letters, range, 67% in 2018-2019 to 77% in 2015-2016). Candidates in the family medicine and pediatrics departments had the highest percentages of letters written by women (44% and 40%, respectively). No differences were found in the number of women letter writers by candidate promotion track; however, differences were found by candidate rank (associate professor, 30%; full professor, 23%) and terminal degree (MD/DO, 25%; PhD, 33%; MD-PhD, 20%). Regardless of candidate gender, most evaluation letters were written by men. Women candidates had 15% to 20% more letters authored by women than men candidates (34%-40% vs 18%-23%). The gender pattern of letter writers may reflect implicit biases regarding gender and perceived leadership status, expertise, and success. Adopting policies that promote or require gender diversity among letter writers for promotion candidates may provide an opportunity to encourage faculty to seek diverse networks and recognize the achievements of women faculty.

Introducing Mass Communications Strategies to Medical Students: A Novel Short Session for Fourth-Year Students.

ProblemThe World Health Organization calls on all with quality medical information to share it with the public and combat health misinformation; however, U.S. medical schools do not currently teach students effective communication with lay audiences about health. Most physicians have inadequate training in mass communication strategies.ApproachIn August 2018, a novel 90-minute class at the University of Minnesota Medical School introduced fourth-year medical students to basic skills for communicating with lay audiences through mass media. Instructors were physicians with experience interacting with the general public via radio, op-ed articles, social media, print media, television, and community and legislative advocacy. After a 20-minute lecture and sharing of instructors’ personal experiences, students completed two 30-minute small-group activities. They identified communications objectives and talking points for a health topic, drafting these as Tweets or an op-ed article outline, then presented talking points in a mock press conference with their peers, practicing skills just learned. Pre- and postsurveys documented students’ previous engagement and comfort with future engagement with mass media messaging.OutcomesOver 1 week, 142 students participated in 6 separate classes, and 127 completed both pre- and postsurveys. Before the course, only 6% (7/127) of students had comfortably engaged with social media and 14% (18/127) had engaged with traditional media in their professional roles. After the course, students self-reported an increase in their comfort, perceived ability, and likelihood of using specific communications skills to advocate for their patients (all P < .001).Next StepsThe course will be expanded into a 5-session thread for third- and fourth-year medical students spread over 2 years. This thread will include meeting physicians who engage with lay audiences, identifying best practices for mass health communication, identifying bias and misinformation, “dos and don’ts” of social media, and communication skills for legislative advocacy.

Undue Influence versus Relational Autonomy in Clinical Decision Making #439.

Undue Influence versus Relational Autonomy in Clinical Decision Making #439.

Dyspneic and dizzy.

Journal of Hospital MedicineEarly View CLINICAL CARE CONUNDRUMS Dyspneic and dizzy Sahityasri Thapi MD, Sahityasri Thapi MD Icahn School of Medicine at Mount Sinai, New York, New York, USASearch for more papers by this authorSurafel Tsega MD, Corresponding Author Surafel Tsega MD surafel.tsega@mountsinai.org orcid.org/0000-0002-0814-3984 @drtsega Icahn School of Medicine at Mount Sinai, New York, New York, USA Division of Hospital Medicine, Department of Medicine, The Mount Sinai Hospital, New York, New York, USA Correspondence Surafel Tsega, MD, Icahn School of Medicine at Mount Sinai, New York, NY, USA. Email: surafel.tsega@mountsinai.org; Twitter: @drtsegaSearch for more papers by this authorConnie Zhao MD, Connie Zhao MD Department of Medicine, The Mount Sinai Hospital, New York, New York, USASearch for more papers by this authorAndrew P. J. Olson MD, Andrew P. J. Olson MD @andrewolsonMD Departments of Medicine and Pediatrics, University of Minnesota Medical School, Minneapolis, Minnesota, USASearch for more papers by this authorStephanie V. Sherman MD, Stephanie V. Sherman MD orcid.org/0000-0002-9726-500X @StephVSherman Department of Medicine, Baylor College of Medicine, Houston, Texas, USASearch for more papers by this author Sahityasri Thapi MD, Sahityasri Thapi MD Icahn School of Medicine at Mount Sinai, New York, New York, USASearch for more papers by this authorSurafel Tsega MD, Corresponding Author Surafel Tsega MD surafel.tsega@mountsinai.org orcid.org/0000-0002-0814-3984 @drtsega Icahn School of Medicine at Mount Sinai, New York, New York, USA Division of Hospital Medicine, Department of Medicine, The Mount Sinai Hospital, New York, New York, USA Correspondence Surafel Tsega, MD, Icahn School of Medicine at Mount Sinai, New York, NY, USA. Email: surafel.tsega@mountsinai.org; Twitter: @drtsegaSearch for more papers by this authorConnie Zhao MD, Connie Zhao MD Department of Medicine, The Mount Sinai Hospital, New York, New York, USASearch for more papers by this authorAndrew P. J. Olson MD, Andrew P. J. Olson MD @andrewolsonMD Departments of Medicine and Pediatrics, University of Minnesota Medical School, Minneapolis, Minnesota, USASearch for more papers by this authorStephanie V. Sherman MD, Stephanie V. Sherman MD orcid.org/0000-0002-9726-500X @StephVSherman Department of Medicine, Baylor College of Medicine, Houston, Texas, USASearch for more papers by this author First published: 30 March 2022 https://doi.org/10.1002/jhm.12815 This icon represents the patient's case. Each paragraph that follows represents the discussant's thoughts. Read the full textAboutPDF ToolsRequest permissionExport citationAdd to favoritesTrack citation ShareShare Give accessShare full text accessShare full-text accessPlease review our Terms and Conditions of Use and check box below to share full-text version of article.I have read and accept the Wiley Online Library Terms and Conditions of UseShareable LinkUse the link below to share a full-text version of this article with your friends and colleagues. Learn more.Copy URL Share a linkShare onFacebookTwitterLinked InRedditWechat Early ViewOnline Version of Record before inclusion in an issue RelatedInformation

Implementing Clinic First Guiding Actions Across 4 Family Medicine Residency Clinics.

Family medicine faculty and residents have observed that continuity clinic is often unsatisfying, attributed to a lack of patient and team continuity and erratic clinic schedules pieced together after the prioritization of hospital service and rotation schedules. In 2019, a 3-year Clinic First project, called Clinic as Curriculum (CaC), was launched across the 4 family medicine residencies of the Department of Family Medicine and Community Health, University of Minnesota Medical School. The department began publishing quarterly CaC dashboard data. Each clinic completed a baseline assessment of their performance on the 13 Building Blocks of High-Performing Primary Care. Using their baseline data, each clinic identified which block or blocks, in addition to the blocks on continuity of care and resident scheduling, to focus on. The plan is to collaboratively implement the overall and local goals using dashboard data and iterative process improvement over 3 years. At baseline, clinics functioned quite well with respect to the 13 building blocks, but CaC dashboard data varied across the 4 clinics, with large variation between clinics on how frequently faculty were scheduled in the clinic and the proportion of total clinic visits seen by faculty. Resident continuity rates were low (range, 38%-47%). Level loading (consistent physician availability to meet patient demand) rates ranged from 1 to 11 days a month. Regarding resident schedules, 2 programs are moving from 4-week to 2-week inpatient blocks, and 2 programs are exploring longitudinal scheduling. One clinic will assign faculty and residents to specific clinic days. Two clinics are implementing microteams of 1 faculty and 3-4 residents. The authors plan to analyze the dashboard data longitudinally; explore microteams, team continuity, and team scheduling adherence; and develop and implement resident scheduling changes over the next 3 years.

First Person Profile: Smita Bhatia, MD, MPH

First Person Profile: Smita Bhatia, MD, MPH

Weaving pathways: talking with our Elders.

While there exists a relative paucity of completed healthcare directives nationally in the USA, even fewer exist within minority populations. This report describes one model for bringing advance care planning and discussions to American Indian and Alaska Native (AIAN) communities. In 2018, Honoring Choices of Minnesota approached the Center of American Indian and Minority Health (CAIMH), housed in the University of Minnesota Medical School, to collaborate on a project to increase healthcare directives in AIAN communities. CAIMH assembled AIAN students, faculty and community members to identify and address barriers to healthcare directive completion and discussions about end-of-life choices. The project team decided upon a two-pronged approach: culturally informed provider training paralleling culturally relevant community engagement. We aimed to empower AIAN to engage with healthcare providers on decisions impacting their care. To further support AIAN patients and their providers, a toolkit was created and will soon be available for dissemination.