Health care costs for adolescents and young adults with cancer: a Wisconsin community-based hospital study between 2005 and 2020.

Introduction: Adolescents and young adults (AYA) with cancer are at risk of high cumulative healthcare system costs potentially associated with poor health and financial outcomes. Although this has been studied at academic centers, little data on AYA costs at community-based practices exist. The goals of this study were to understand direct health care costs for AYA patients, identify factors for high costs, and assess how total health care costs may relate to survival.

Intentional or Not: Teamwork Learning at Primary Care Clinics.

Background And Objectives: Primary care teamwork has been shown to increase satisfaction and decrease stress for physicians but the impact of outpatient teamwork for primary care residents' learning has not been described. This study aimed to understand the role of teamwork in residents' learning during and after the establishment of teams.

Methods: Interviews with 37 primary care residents addressed their experiences at outpatient clinic, including their perceptions about whether team-based care affected their educational experience.

Annual Performance Reviews Of, For and By Faculty: A Qualitative Analysis of One Department's Experiences.

Purpose: Although annual performance reviews and feedback are recommended for faculty development, best practices and faculty perceptions have not been documented. The authors sought to evaluate the process in one medical school department that established and has sustained an innovative review tradition for 25 years.

Method: Content analysis of faculty reports and immersion/crystallization to analyze interviews.

Working around hierarchy: Resident and medical assistant teaming.

Background: In health care, hierarchy can facilitate getting work done efficiently. It can also hinder performance by suppressing valuable contributions from lower-positioned individuals. Team-based care could mitigate negative effects by creating space for all team members to contribute their unique expertise.

Establishing Teams: How Does It Change Practice Configuration, Size, and Composition?

Little is known about how practices reorganize when transitioning from traditional practice organization to team-based care. We compared practice-level (1) configuration as well as practice- and team-level (2) size and (3) composition, before and after establishing teams. We employed a pre-/poststudy using personnel lists of 1571 to 1711 staff (eg, job licenses, titles, and team assignment) and practice manager surveys.

Feeling inadequate: Residents' stress and learning at primary care clinics in the United States.

Background: Educators hope that residents' experiences in primary care continuity clinics will influence more trainees to enter primary care careers. Unfortunately, evidence shows that outpatient primary care training in the United States is stressful and fails to promote primary care careers. We conducted qualitative interviews with residents to understand the source of stress and to explain this failure.

Team-based primary care: The medical assistant perspective.

Background: Team-based care has the potential to improve primary care quality and efficiency. In this model, medical assistants (MAs) take a more central role in patient care and population health management. MAs' traditionally low status may give them a unique view on changing organizational dynamics and teamwork.

Team dynamics, clinical work satisfaction, and patient care coordination between primary care providers: A mixed methods study.

Background: Team-based care is essential for delivering high-quality, comprehensive, and coordinated care. Despite considerable research about the effects of team-based care on patient outcomes, few studies have examined how team dynamics relate to provider outcomes.

Purpose: The aim of this study was to examine relationships among team dynamics, primary care provider (PCP) clinical work satisfaction, and patient care coordination between PCPs in 18 Harvard-affiliated primary care practices participating in Harvard's Academic Innovations Collaborative.

A faculty development program integrating cross-cultural care into a gastrointestinal pathophysiology tutorial benefits students, tutors, and the course.

A specific faculty development program for tutors to teach cross-cultural care in a preclinical gastrointestinal pathophysiology course with weekly longitudinal followup sessions was designed in 2007 and conducted in the same manner over a 6-yr period. Anonymous student evaluations of how "frequently" the course and the tutor were actively teaching cross-cultural care were performed. The statements "This tutor actively teaches culturally competent care" and "Issues of culture and ethnicity were addressed" were significantly improved over baseline 2004 data.

Development and validation of the primary care team dynamics survey.

Objective: To develop and validate a survey instrument designed to measure team dynamics in primary care.

Data Sources/study Setting: We studied 1,080 physician and nonphysician health care professionals working at 18 primary care practices participating in a learning collaborative aimed at improving team-based care.

Study Design: We developed a conceptual model and administered a cross-sectional survey addressing team dynamics, and we assessed reliability and discriminant validity of survey factors and the overall survey's goodness-of-fit using structural equation modeling.

50 years of publication in the field of medical education.

Background: The advent of new medical education (ME) journals makes evident the growth of the field of ME. However, the nature and context of growth is undefined.

Aim: To analyze the evolution of publication in ME.

Extensive sinovenous thrombosis and hemorrhagic infarction during therapy for T-cell acute lymphoblastic leukemia.

Sinovenous thrombosis (SVT) is a well-recognized and serious complication in children treated for acute leukemia. This frequently occurs during or immediately upon completion of induction therapy and is commonly attributed to asparaginase therapy.Headache is the first and most common clinical symptom to occur during the early development of SVT.

Compound heterozygosity for MSH6 mutations in a pediatric lymphoma patient.

An 8-year-old male with lymphoblastic lymphoma was noted to have multiple café-au-lait macules and possible Lisch nodules. Work-up revealed the child as compound heterozygous for mutations in the DNA mismatch repair gene, MSH6. This case emphasizes many clinical issues regarding individuals with biallelic mismatch repair mutations, a rare and easily missed hereditary predisposition to childhood cancer.

Integration of racial, cultural, ethnic, and socioeconomic factors into a gastrointestinal pathophysiology course.

Background & Aims: Our study describes a faculty development program to encourage the integration of racial, cultural, ethnic, and socioeconomic factors such as obesity, inability to pay for essential medications, the use of alternative medicine, dietary preferences, and alcoholism in a gastrointestinal pathophysiology course.

Methods: We designed a 1-hour faculty development session with longitudinal reinforcement of concepts. The session focused on showing the relevance of racial, ethnic, cultural, and socioeconomic factors to gastrointestinal diseases, and encouraged tutors to take an active and pivotal role in discussion of these factors.

How important is money as a reward for teaching?

Purpose: To examine the effect of increases in payment for teaching on retention of primary care faculty, and to compare those faculty members' needs and rewards for teaching with objective data on retention.

Method: In 2006-2007, the authors compared retention rates of primary care clerkship preceptors at Harvard Medical School (1997-2006) when their stipends were raised from $600 to $900 (in 2003) and to $2,500 (in 2004), and when faculty received payment directly versus indirectly. A survey was sent to all 404 present and past living preceptors, who were asked to rank-order six factors in terms of (1) how much they needed each to continue teaching, and (2) each factor's contribution to their satisfaction with teaching.

A self-instructional model to teach systems-based practice and practice-based learning and improvement.

Background: When mandated as resident competencies in 1999, systems-based practice (SBP) and practice-based learning and improvement (PBLI) were new concepts to many.

Objective: To describe and evaluate a 4-week clinical elective (Achieving Competence Today-ACT) to teach residents SBP and PBLI.

Design: ACT consisted of a four-week active learning course and follow-up teaching experience, guided and supported by web-based materials.

Teaching population health as a basic science at Harvard Medical School.

In 2006-2007, Harvard Medical School implemented a new, required course for first-year medical and dental students entitled Clinical Epidemiology and Population Health. Conceived of as a "basic science" course, its primary goal is to allow students to develop an understanding of caring for individuals and promoting the health of populations as a continuum of strategies, all requiring the engagement of physicians. In the course's first iteration, topical content accessible to first-year students was selected to exemplify physicians' roles in addressing current threats to population health.

Inherited ADAMTS13 deficiency: unique presentation and treatment.

A 3-year-old male presented with severe thrombocytopenia and microangiopathic hemolytic anemia in conjunction with severe bilateral otitis media. After laboratory analysis, a diagnosis of inherited ADAMTS13 deficiency was proven. Rather than treating with prophylactic fresh frozen plasma, to date the patient has been successfully treated with single-donor, directed plasma infusions in response to early signs of relapse.

Cooperative learning: a new application of problem-based learning in mental health training.

Interaction in problem-based learning (PBL) tutorials is not necessarily cooperative, which may account for variation in learning outcomes. Therefore, a cooperative assessment structure was introduced in a PBL course and the difference examined between this method and individual, lecture-based learning in mental health training. Experimental student groups gained more knowledge between pre- and post-test than did control groups, and the experimental students who scored low on the pre-test made the greatest gains.

Creating enduring change: demonstrating the long-term impact of a faculty development program in palliative care.

Background: Improved educational and evaluation methods are needed in continuing professional development programs.

Objective: To evaluate the long-term impact of a faculty development program in palliative care education and practice.

Design: Longitudinal self-report surveys administered from April 2000 to April 2005.

Teaching care management in a longitudinal primary care clerkship.

Background: Harvard Medical School developed a longitudinal primary care clerkship as an opportunity to teach 7 themes of modern medicine: care over time, evidence-based medicine, prevention, uncertainty, cost effectiveness, teamwork, and shared decision making.

Purpose: To evaluate the effectiveness of the longitudinal experience.

Methods: Students followed 1 patient throughout a 9-month clerkship and integrated the 7 themes into their management plans.

Teaching and learning end-of-life care: evaluation of a faculty development program in palliative care.

Purpose: To evaluate the effectiveness of the Program in Palliative Care Education and Practice (PCEP), an intensive faculty development program at Harvard Medical School.

Method: PCEP is a two-week program offered annually with two on-site sessions in Boston, MA, and an interim period distance-learning component. Training integrates palliative care clinical skill development, learning theory and teaching methods, and leadership and organizational change.

Preparing faculty to teach managing care competencies: lessons learned from a national faculty development program.

Background: Although competencies for managing care are often described in the medical literature, educators have been slow to integrate these competencies into clinical curricula. Backlash against managed care has created a skeptical educational environment. Many faculty feel unprepared to teach the competencies in clinical settings.

How do precepting physicians select patients for teaching medical students in the ambulatory primary care setting?

Objective: To study how clinical preceptors select patients for medical student teaching in ambulatory care and to explore key factors they consider in the selection process.

Design: Qualitative analysis of transcribed interviews.

Setting: Harvard Medical School, Boston, Mass.