West Virginia University School Research Articles

Four-year longitudinal culinary and lifestyle medicine track for undergraduate medical students: development and implementation

ABSTRACT The importance of culinary and lifestyle medicine education to combat the growing burden of chronic disease is gaining recognition in the United States. However, few medical schools offer in-depth training with a 4-year longitudinal track. The Culinary and Lifestyle Medicine Track (CLMT) is a 4-year curriculum thread created at West Virginia University School of Medicine to address the need for comprehensive culinary and lifestyle medicine education. CLMT teaches concepts of healthy nutrition, physical activity, stress management, and restorative sleep. CLMT students complete approximately 300 h of in-person and virtual culinary and lifestyle medicine education, including hands-on teaching kitchens, distributed over the preclinical and clinical years. Students are selected into the track prior to matriculation after an application and interview process. The students have exceeded expectations for scholarly and community activity. Track graduates have entered into primary care as well as specialty and surgical residencies, demonstrating that lifestyle education plays a role for students interested in a wide range of careers. Exit survey responses from learners reflected tangible and intangible benefits of participation and offered constructive feedback for improvement. Presented here are the components of the curricular design, implementation, and initial outcomes.

The development and evaluation of a short-term international student research and educational program

ObjectivesThis study aimed to describe the “how-to” details and processes for developing and evaluating a short-term international student research and education program. MethodsThis study included two parts: development and implementation, and evaluation of the program. A foreign doctoral nursing student requested to visit the West Virginia University School of Nursing for research training and academic teaching experience. The global nursing program coordinator and the lead mentor met and identified the program basis and team participants. Learning activities were related to this student’s interest in older adults and in-home end-of-life care, included four contents: research; educational engagement; practice/clinical engagement; special activities & professional development training and courses. The program evaluation was conducted at the end of the six-month visit using a focus group and an anonymous short survey. Participants (n = 10) included the host university’s faculty, graduate students, and one short-term international student. ResultsContent analysis of the participant’s short survey answers and the focus group discussion resulted in three themes: 1) lessons learned from participating in the program (enhanced diversity in education and research, gaining new global healthcare knowledge, and self-reflection on and promoting cultural awareness); 2) program barriers and challenges (the visa application process, the English language barrier, the lack of public transportation in the town, and scheduling conflicts); and 3) strategies to overcome these barriers and challenges (adding cultural diversity information into curriculum; attending English proficiency with others in the class; using different communication techniques; continuous collaboration with the University’s Office of Global Affairs for the Visa application process; providing interactive experiences). All participants rated their engagement in the program as very satisfactory (Mean = 4.67, SD = 0.50), and highly impacted their nursing skills in research, teaching, and clinical practice (Mean = 4.67, SD = 0.50). ConclusionsAll the participants have gained some experience in this program, which can be used for future teaching guidance. Further, international nursing students need assistance to adjust and thrive in the host university learning community. Faculty must be culturally sensitive, understand the visiting foreign nursing student’ learning needs, and advocate for an environment suitable for enhancing the students’ learning.

News from the European Journal of Therapeutics: A new issue and a new editorial board

News from the European Journal of Therapeutics: A new issue and a new editorial board

Factors Associated With the Acceptance of Military Applicants to a U.S. Allopathic Medical School.

Service members and veterans applying to medical schools can be a challenging experience. Often, the applicants have difficulty providing descriptions of their experiences. Additionally, their pathway to medical school is significantly different compared to traditional applicants. We sought to determine if there were statistically significant factors within a cohort of U.S. military medical school applications to a U.S.-based allopathic medical school to provide recommendations on how to best advise military applicants. Data about social, academic, and military factors were collected and analyzed from the American College Application Service (AMCAS) applications to the West Virginia University School of Medicine (WVU SoM) from the 2017 to 2021 cycles. Eligibility criteria included the applications that indicated that the applicant listed any type of military experience. In the 5-year study period, there were 25,514 applicants to the WVU SoM, and 1.6% (n = 414) self-identified as military applicants. Of the military applicants, 28 (7%) were accepted to the WVU SoM. Statistically significant differences were found in several factors, including but not limited to academic performance, number of total experiences (14.5 vs. 12, P = .01), and number of military experiences (4 vs. 2, P = .003) listed on the AMCAS applications. In the accepted group, 88% of the applications included information about military experiences, which was understandable to the nonmilitary researchers compared to 79% in the nonaccepted group (P = .24). Premedical advisors can share statistically significant findings with military applicants, so they are informed about the academic and experiential factors associated with medical school acceptance. Applicants should also be advised to provide clear explanations of any military lexicon used in their applications. Although not statistically significant, there were a higher percentage of applications that contained descriptions of military language that was understandable to the civilian researchers in the accepted group vs. the nonaccepted group.

Integration of tobacco treatment specialist (TTS) training into dental and dental hygiene curricula.

Integration of tobacco treatment specialist (TTS) training into dental and dental hygiene curricula.

Adapting the layered learning model to a virtual international exchange program

IntroductionThe layered learning model (LLM) is a well-established teaching approach designed for attending preceptors to train post-graduate learners and to precept students. The adaptation of a LLM to a virtual exchange program has not been previously described. The purpose of this study was to evaluate the effectiveness of the longitudinal virtual international exchange program in applying principles of the LLM to multiple levels of learners and instructors at West Virginia University (WVU) School of Pharmacy and Kitasato University (KU) School of Pharmacy. MethodsThe online survey piloted the impact of applying the LLM to virtual international exchange sessions on improving participant knowledge in pharmacy practice, pharmacy education, cultural practices, and cultural awareness. The survey questions assessed the program's structure and effectiveness in achieving learning outcomes related to pharmacy residency topics and cultural competency using a five-point Likert scale. ResultsMedian scores of the effectiveness of the virtual international exchange program structure were high (≥ 4.0). Two questions evaluating the use of the LLM had median scores of 4.0. All nine residency-related questions were rated ≥3.0. The median scores for three questions evaluating small group discussions and the use of the LLM were rated significantly higher by WVU participants than KU participants. There were no significant differences in program structure and learning outcome ratings between participant groups (student vs. resident/fellow vs. preceptor/faculty). ConclusionsApplication of the LLM to the virtual international exchange program was positively received by participants, particularly by United States participants.

The Appalachia Mind Health Initiative (AMHI): a pragmatic randomized clinical trial of adjunctive internet-based cognitive behavior therapy for treating major depressive disorder among primary care patients

BackgroundMajor depressive disorder (MDD) is a leading cause of disease morbidity. Combined treatment with antidepressant medication (ADM) plus psychotherapy yields a much higher MDD remission rate than ADM only. But 77% of US MDD patients are nonetheless treated with ADM only despite strong patient preferences for psychotherapy. This mismatch is due at least in part to a combination of cost considerations and limited availability of psychotherapists, although stigma and reluctance of PCPs to refer patients for psychotherapy are also involved. Internet-based cognitive behaviorial therapy (i-CBT) addresses all of these problems.MethodsEnrolled patients (n = 3360) will be those who are beginning ADM-only treatment of MDD in primary care facilities throughout West Virginia, one of the poorest and most rural states in the country. Participating treatment providers and study staff at West Virginia University School of Medicine (WVU) will recruit patients and, after obtaining informed consent, administer a baseline self-report questionnaire (SRQ) and then randomize patients to 1 of 3 treatment arms with equal allocation: ADM only, ADM + self-guided i-CBT, and ADM + guided i-CBT. Follow-up SRQs will be administered 2, 4, 8, 13, 16, 26, 39, and 52 weeks after randomization. The trial has two primary objectives: to evaluate aggregate comparative treatment effects across the 3 arms and to estimate heterogeneity of treatment effects (HTE). The primary outcome will be episode remission based on a modified version of the patient-centered Remission from Depression Questionnaire (RDQ). The sample was powered to detect predictors of HTE that would increase the proportional remission rate by 20% by optimally assigning individuals as opposed to randomly assigning them into three treatment groups of equal size.Aggregate comparative treatment effects will be estimated using intent-to-treat analysis methods. Cumulative inverse probability weights will be used to deal with loss to follow-up. A wide range of self-report predictors of MDD heterogeneity of treatment effects based on previous studies will be included in the baseline SRQ. A state-of-the-art ensemble machine learning method will be used to estimate HTE.DiscussionThe study is innovative in using a rich baseline assessment and in having a sample large enough to carry out a well-powered analysis of heterogeneity of treatment effects. We anticipate finding that self-guided and guided i-CBT will both improve outcomes compared to ADM only. We also anticipate finding that the comparative advantages of adding i-CBT to ADM will vary significantly across patients. We hope to develop a stable individualized treatment rule that will allow patients and treatment providers to improve aggregate treatment outcomes by deciding collaboratively when ADM treatment should be augmented with i-CBT.Trial registrationClinicalTrials.gov NCT04120285. Registered on October 19, 2019.

From Bingo to Certified Medical Director: How the Futures Program Helped Solidify My Journey

I first stepped into a nursing home when I was six years old. My mother was a certified nursing assistant who always worked 12-hour shifts. Since my father was also working, sometimes she had no choice but to have the bus drop me off at the long-term care facility where she worked. On those days I would sit in the dining hall with the residents who were under my mother’s care. I vividly remember playing bingo and poker with them. Those memories, glimpses of a moment in time, became the foundation for my career. Pursuing a geriatric medicine fellowship was an easy decision for me. During my interview with University of Pittsburgh Medical Center (UPMC) Presbyterian–Shadyside, I expressed an interest in post-acute and long-term care settings. That was when I first heard of the Futures Program, an opportunity that immediately appealed to me. I wanted to spend more time improving the ways that we care for our most vulnerable populations, and I also wanted to seek guidance and support for becoming a certified medical director. And after two years under a pandemic, I looked forward to an in-person conference! When we gathered in Baltimore, MD, at the 2022 Annual Conference of AMDA – The Society for Post-Acute and Long-Term Care Medicine, I felt invigorated by the small group sessions, the Q&As, and the larger events that Futures Program participants could take part in. It was rewarding just to be in the same room with so many people who shared my passion for this field, and the learning opportunities were seemingly endless. Throughout the conference I looked for pieces of advice that could follow me back to UPMC. Wayne Saltzman, MD, PhD, CMD, delivered an excellent presentation in which he asked us to remember five simple rules that would help us prevent adverse events. At one point in his presentation Dr. Saltzman said, “A good day starts with a good morning,” and that has stuck with me. He spoke of entering his facility at the start of busy days, and despite challenging situations, he said he always will take time to wish his staff a good morning. Since then, I have introduced myself to more of the staff at our nursing home, which has fostered better communication and better overall care. The leadership session, hosted by Suzanne Gillespie, MD, RD, CMD, and Elizabeth Galik, PhD, CRNP, opened my eyes to how many mentors had already helped me get to this point. It was then that I truly understood how the Futures Program gives rising clinical leaders in geriatrics a chance to find new mentors. Drs. Gillespie and Galik also asked us to reflect on our goals and values and consider how we bring them into the work that we do. In doing so, I was reminded of the little girl who enjoyed sitting with the residents, the one who went on to become a medical student and physician who spent all her electives in PALTC. Joining the Futures Program felt like a natural fit. I left that session with a solidified goal: become a certified medical director but never lose sight of that bingo-playing little girl. I could not be more thankful for the foundation that the Futures Program provides for us, and for the friendships and connections it has helped me make. I look forward to getting more involved with the Society very soon! Dr. Assadzandi is a graduate of Mercyhurst University and West Virginia University School of Medicine, where she also completed her family medicine residency. This June, she is finishing a fellowship with UPMC’s Division of Geriatric Medicine and will then join the department as a clinical assistant professor focusing on post-acute and long-term care.

Thirteen Synchronous Multifocal Calcifying Epithelial Odontogenic Tumors (CEOT): Case Report and Review of the Literature

<h3>Introduction</h3> Calcifying epithelial odontogenic tumor (CEOT, Pindborg tumor) is a rare benign, locally aggressive neoplasm of the jaws that accounts for approximately 1% of all odontogenic tumors. The CEOT was first defined by Pindborg in 1955 and has been reported approximately 350 times in the literature; 7 of these reported multiple, synchronous lesions (up to 4). We report the eighth case in an individual with the largest number (by far) of CEOTs reported to date and provide a literature review of multifocal CEOT cases. <h3>Materials and methods</h3> A 30-year-old male presented to the Oral and Maxillofacial Surgery Department of the West Virginia University School of Dentistry (WVU SoD) to extract multiple impacted teeth previous to constructing a complete denture. <h3>Results</h3> A pantograph showed 15 impacted teeth, almost all associated with well-demarcated cyst-like radiolucencies, some with small, ill-defined radiopaque flecks. Microscopically the lesions showed sheets of strands of polygonal epithelial cells with eosinophilic cytoplasm. Spread throughout the epithelium and connective tissue were small spherical amorphous pale purplish calcifications. Each lesion was similar and consistent with a diagnosis of CEOT. <h3>Conclusion</h3> We report a patient with 13 independent CEOTs scattered throughout all quadrants, suggesting genetic mutation of a tumor suppressor gene, such as the PTCH1 gene, which has been previously identified in patients with solitary CEOTs. This is the largest number of Pindborg tumors or any other type of odontogenic tumors, yet reported in a single individual.

Invited Perspective: PFAS and Liver Disease: Bringing All the Evidence Together.

Invited Perspective: PFAS and Liver Disease: Bringing All the Evidence Together.

Undaunted trailblazers and unfinished work.

Journal of Dental EducationVolume 85, Issue 11 p. 1692-1694 PERSPECTIVES Undaunted trailblazers and unfinished work Shelia S. Price DDS, EdD, MA, FACD, Corresponding Author Shelia S. Price DDS, EdD, MA, FACD [email protected] West Virginia University School of Dentistry, Morgantown, West Virginia, USA Correspondence Shelia Price, DDS, EdD, MA, FACD, West Virginia University School of Dentistry, Morgantown, West Virginia, USA. Email: [email protected]Search for more papers by this authorJeanne C. Sinkford DDS, PhD, FACD, Jeanne C. Sinkford DDS, PhD, FACD American Dental Education Association, Howard University College of Dentistry, Washington, District of Columbia, USASearch for more papers by this authorMarilyn P. Woolfolk DDS, MS, MPH, FACD, Marilyn P. Woolfolk DDS, MS, MPH, FACD University of Michigan, Ann Arbor, Michigan, USASearch for more papers by this authorKaren P. West DMD, MPH, FACD, Karen P. West DMD, MPH, FACD American Dental Education Association, Washington, District of Columbia, USASearch for more papers by this author Shelia S. Price DDS, EdD, MA, FACD, Corresponding Author Shelia S. Price DDS, EdD, MA, FACD [email protected] West Virginia University School of Dentistry, Morgantown, West Virginia, USA Correspondence Shelia Price, DDS, EdD, MA, FACD, West Virginia University School of Dentistry, Morgantown, West Virginia, USA. Email: [email protected]Search for more papers by this authorJeanne C. Sinkford DDS, PhD, FACD, Jeanne C. Sinkford DDS, PhD, FACD American Dental Education Association, Howard University College of Dentistry, Washington, District of Columbia, USASearch for more papers by this authorMarilyn P. Woolfolk DDS, MS, MPH, FACD, Marilyn P. Woolfolk DDS, MS, MPH, FACD University of Michigan, Ann Arbor, Michigan, USASearch for more papers by this authorKaren P. West DMD, MPH, FACD, Karen P. West DMD, MPH, FACD American Dental Education Association, Washington, District of Columbia, USASearch for more papers by this author First published: 27 October 2021 https://doi.org/10.1002/jdd.12809Read 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 No abstract is available for this article. Volume85, Issue11November 2021Pages 1692-1694 RelatedInformation

Anna Kiger, DNP, DSc, MBA, RN, NEA-BC, FAONL

Dr. Kiger is the System Chief Nurse Officer for Sutter Health, a not-for-profit integrated healthcare system operating in the Northern California and San Francisco Bay area. As the system’s first Chief Nurse Officer, Dr. Kiger is accountable for executive nursing leadership, clinical nursing practice, education, nursing research, and workforce labor optimization. Anna holds a Doctor of Nursing Practice from Texas Tech University School of Nursing, a Doctorate of Science in Public Health, Health Systems Management, from Tulane School of Public Health & Tropical Medicine, an MBA from Averett University, Danville Virginia and a Master of Science in Nursing from Duquesne University in Pittsburgh, PA. Her undergraduate BSN is from West Virginia University School of Nursing. Dr. Kiger serves as a Board Regent for Samuel Merritt University in Oakland, California, as Board member for MedicAlert Foundation in Turlock, CA and as a Board member for HealthImpact in Oakland, CA. Finally, Dr Kiger also serves on the Editorial Board for the Journal of Nursing Administration (JONA) and for Voice of Nursing Leadership, both publications of the American Organization for Nurse Leaders (AONL).

Appalachian Culture &amp; History, An Important Lesson for Incoming Medical Students

INTRODUCTION There is an expectation that medical students will be exposed to and gain cultural competence prior to graduation. It is prudent to ensure that cultural competence education starts early in the medical school curriculum. METHODS A 90-minute educational session ("Appalachian Culture and History") was created at the West Virginia University School of Medicine as a part of the cultural competency curriculum to better introduce and orient new medical school matriculates to the culture and history of both the state and Appalachia. Students anonymously completed on-line evaluations at the conclusion of the session to rate the quality of the presentation on a five-point scale which ranged from 1 (" very dissatisfied ") to S ("extremely satisfied "). RESULTS Students rated the session at a mean of 4.52, 4.37, and 4,53 in 2018, 2019, and 2020 respectively. Positive comments were generated by in-state and out-of-state students. DISCUSSION Matriculating students have been overwhelmingly satisfied with the Appalachian Culture and History educational session based upon anonymous evaluations. CONCLUSIONS As the majority of medical students have positively appraised the Appalachian Culture and History educational session, there is reason to believe they will be better prepared to learn from and care for patients from Appalachia.

West Virginia University School of Medicine

West Virginia University School of Medicine

Clinical Implications of the Submental and Sublingual Arteries in Relation to the Mylohyoid Boutonnière.

Mylohyoid musculature may be included in the submental artery flap to protect perforators. However, blood vessels may pass through the mylohyoid muscle and therefore cause bleeding and risk to pedicle or perforator injury when a mylohyoid-containing flap is lifted. The objectives of this study were to identify the prevalence of the submental and sublingual arteries that traverse the mylohyoid and to assess relationships between vasculature transmitted through mylohyoid muscles and mylohyoid boutonnières. Cross-sectional human cadaveric study. The West Virginia University School of Medicine human gross anatomic laboratories. A total of 43 intact mylohyoid muscles from 22 cadavers were dissected. The prevalence of submental vasculature perforating the mylohyoid was recorded in addition to the prevalence and contents of mylohyoid boutonnières. Of 43 mylohyoid muscles, 21 (48.8%) transmitted the submental or sublingual arteries, and 30 (69.1%) possessed boutonnières. One muscle had 2 boutonnières. Of 31 mylohyoid boutonnières, 21 transmitted blood vessels (67.7%). Specifically, 9 transmitted an artery and a vein (29.0%), and 12 transmitted an artery (38.7%). Ten boutonnières (32.3%) were exclusively occupied by fascia. This report identifies the importance of identifying and carefully ligating branches of the submental artery that pierce the mylohyoid during elevation of the submental island flap. This report also identifies that a boutonnière is often present where a submental or sublingual artery is traversing the mylohyoid to supply sublingual glands, tongue, and anterior mandible.

Dr Millar Obituary

*Shriners Hospital for Children, Chicago, IL †Department of Orthopaedics, West Virginia University School of Medicine, Morgantown, WV The authors have no disclosures that are relevant to this manuscript nor have they received any financial support. The authors declare no conflicts of interest. Reprints: John P. Lubicky, MD, Department of Orthopaedics, West Virginia University School of Medicine, 64 Medical Center Drive, Morgantown, WV 26506 (e-mail: [email protected]).

Development of coupled patient care experience courses to enhance patient care skills in the ambulatory and acute care settings

Background and purposeProviding opportunities to allow pharmacy students to apply clinical skills is essential to ensure that they are comfortable and competent to perform these skills during advanced pharmacy practice experiences (APPEs) and in practice. We describe unique coupled courses that require students to apply clinical skills during real patient encounters and simulation activities in the ambulatory and acute care setting to ensure that they are ready for APPEs. Educational activity and settingNew required courses were developed at West Virginia University School of Pharmacy that focused on teaching and reinforcing patient care skills in the ambulatory and acute care settings. Both courses were designed to provide students with multiple opportunities to offer supervised patient care and to become more comfortable and confident in their patient care skills. FindingsThe coupled courses were well-received by students. Feedback indicated that students felt more comfortable in these patient care settings and in performing patient care activities as a result of these courses. SummaryThese coupled courses offered multiple opportunities for students to practice patient care skills and gain valuable experience participating in activities that increased their confidence and competence at being integral members of the healthcare team. The interactions with real patients, simulated patient scenarios, standardized patients, and other members of the healthcare team helped students advance communication skills, clinical skills, and ability to identify and resolve medication-related problems in preparation for APPEs.

Expanding an anatomy division during a curricular reduction in medical anatomy ‐ Turn that frown upside down!

At West Virginia University (WVU) School of Medicine, a new curricular revision has reduced the Human Structure course, which includes gross anatomy, ultrasound, histology, and embryology, from a 14 week course to a 9 week course for first year medical students. This curricular modification also limits student contact to 15 hours a week, moves the Human Structure course from the spring to the fall semester, reschedules exam days from Mondays to Fridays, limits the coverage of new course content during exam weeks, and reduces the number of exams and assessments testing student learning. In response to these drastic changes, this new Human Structure course will reduce the number of lectures and laboratory (anatomy, ultrasound, and histology) sessions, change small group dissections to prosections, rotate students through the dissection laboratory in two groups to reduce contact time, and move a majority of the histology content to an online format, limiting the use of microscopes within the course. Throughout this transition period, the WVU Anatomy Division within the Pathology, Anatomy, and Laboratory Medicine Department has still been able to grow and remain relevant. Improvements within the Anatomy Division include, but are not limited to, recruitment of new faculty members, building two new dissection laboratories, securing funding for the construction of a new morgue to house the anatomical donors in the Human Gift Registry, and increasing the number of anatomy courses taught by faculty members within our Anatomy Division. Despite the reduction in coverage of the anatomical sciences to medical students, the demand for new anatomy courses has risen with the added benefit of teaching many new cohorts of students, including physician assistants, occupational therapists, and undergraduate students in exercise physiology, music therapy, and athletic training. More importantly, all anatomy courses taught within the WVU Health Sciences Center (HSC) will be moved under the direction of the Anatomy Division. Despite some bumps in the curricular landscape, anatomy instruction at the WVU HSC will continue to grow, offer new courses to a more diverse student population, and impact student learning.

Editorial introductions

Editorial introductions

Perceptions and Practices of Primary Care Physicians Regarding Proton Pump Inhibitors

Introduction: Adverse effects associated with proton pump inhibitor (PPI) use are well-documented in medical literature and have become a subject of great interest. Although highly efficacious, the indiscriminant use of PPIs has led to a concern about risks related with over prescription and indefinite usage. Primary care physicians (PCPs) are largely responsible for medically managing the population at risk for excessive PPI use. We studied the knowledge, perceptions, and practices of residents and attending physicians in primary care specialties at a tertiary care university hospital. Methods: We conducted a cross sectional study utilizing survey methods at West Virginia University School of Medicine from March to April, 2018. The study was approved by our Institutional Review Board. Resident and attending physicians in the departments of Internal Medicine and Family Medicine were recruited, and completed the study questionnaire. Data was analyzed using RedCap Software. Results: In a sample of 59 participants comprising 15 attending physicians and 45 residents, 85% reported that greater than 20 patients under their care were using PPIs. However, upon prescribing PPIs, 37% reported that they were either unlikely, or not at all likely to discuss adverse events. Although Clostridium Difficile infection, bone fractures, and kidney disease were correctly identified as adverse effects of PPI's by (74.6%), (86.4%), and (45.8%) of participants respectively, no participant was able to correctly identify all adverse effects associated with PPIs. 78% of participants reported that less than 10% of their patients had inquired about adverse effects of PPIs, word of mouth was the most common medium of learning the potential adverse effects reported by patients, n=24 (40.7%). 31 participants (52%) reported that changing prescribing practices due to the adverse effect profile of PPI's; 80% of the sample reported having discontinued PPIs in 10 patients or less, and 76.3% reported deescalating the doses in 10 patients or less in their practice. Conclusion: Our study explores the perceptions and practices of PCPs regarding to PPI prescription patterns. The knowledge level of participants in our study regarding PPI adverse effects was moderate at best, and although a majority of participants reported concern for PPI adverse effects, this was not translated into a change in practice. Knowing these discrepancies, it is imperative to devise and investigate interventions to improve prescribing behaviors of PCPs.