The Harvard Medical School Pathways curriculum: A comprehensive curricular evaluation.

Purpose: The Harvard Medical School Pathways curriculum represents a major reform effort. Our goals were to enhance reasoning and clinical skills and improve the learning environment and students' approach to learning via use of collaborative, case-based pedagogy; early clinical exposure; and enhanced approaches to teaching and evaluating clinical skills. We evaluated the impact of Pathways on key outcomes related to these goals.

Advanced Integrated Science Courses: Building a Skill Set to Engage With the Interface of Research and Medicine.

Scientific research has been changing medical practice at an increasing pace. To keep up with this change, physicians of the future will need to be lifelong learners with the skills to engage with emerging science and translate it into clinical care. How medical schools can best prepare students for ongoing scientific change remains unclear.

Machine-learning-based predictions of direct-acting antiviral therapy duration for patients with hepatitis C.

Introduction: Hepatitis C, which affects 71 million persons worldwide, is the most common blood-borne pathogen in the United States. Chronic infections can be treated effectively thanks to the availability of modern direct-acting antiviral (DAA) therapies. Real-world data on the duration of DAA therapy, which can be used to optimize and guide the course of therapy, may also be useful in determining quality of life enhancements based upon total required supply of medication and long-term improvements to quality of life.

CNS Metastases in Patients With Exon 14-Altered Lung Cancers and Outcomes With Crizotinib.

Purpose: Although exon 14 (ex14)-altered lung cancers were first identified more than a decade and a half ago, the frequency of CNS metastatic disease remains poorly defined. Furthermore, the seminal trial of crizotinib in these patients (PROFILE 1001) did not report patterns of CNS response or progression.

Patients And Methods: Patients with pathologically confirmed, advanced non-small-cell lung cancers (NSCLC) harboring a ex14 alteration by targeted DNA/RNA sequencing were studied.

Hepatic gap junctions amplify alcohol liver injury by propagating cGAS-mediated IRF3 activation.

Alcohol-related liver disease (ALD) accounts for the majority of cirrhosis and liver-related deaths worldwide. Activation of IFN-regulatory factor (IRF3) initiates alcohol-induced hepatocyte apoptosis, which fuels a robust secondary inflammatory response that drives ALD. The dominant molecular mechanism by which alcohol activates IRF3 and the pathways that amplify inflammatory signals in ALD remains unknown.

The Harvard Medical School Pathways Curriculum: Reimagining Developmentally Appropriate Medical Education for Contemporary Learners.

As the U.S. health care system changes and technology alters how doctors work and learn, medical schools and their faculty are compelled to modify their curricula and teaching methods.

A snapshot of underrepresented physicians 15 years after medical school.

We conducted a study to compare medical school experiences, values, career paths, and career satisfaction of under-represented in medicine (URiM) and non-URiM physicians approximately 15 years after medical school, guided by the Theory of Planned Behavior and the concept of stereotype threat. The sample consisted of four graduating classes, 1996-1999, of Harvard Medical School, 20% of whom were URiM. URiM respondents came from families of lower educational attainment and graduated with more debt.

Do Professionalism Lapses in Medical School Predict Problems in Residency and Clinical Practice?

Purpose: Recognizing that physicians must exhibit high levels of professionalism, researchers have attempted to identify the precursors of clinicians' professionalism difficulties, typically using retrospective designs that trace sanctioned physicians back to medical school. To better establish relative risk for professionalism lapses in practice, however, this relationship must also be studied prospectively. Therefore, this study investigated the sequelae of medical school professionalism lapses by following students with medical school professionalism problems into residency and practice.

Computed Tomography Findings as a Novel Predictor of Alcohol-Associated Hepatitis Outcomes.

Background: Accurate prediction of outcomes for alcohol-associated hepatitis (AH) is critical, as prognosis determines treatment eligibility. Computed tomography (CT) features may provide prognostic information beyond traditional models.

Aims: Our aim was to identify CT features that predict outcomes in AH.

Physicians' Perspectives on Palliative Care for Patients With End-Stage Liver Disease: A National Survey Study.

Specialty palliative care (PC) is underused for patients with end-stage liver disease (ESLD). We sought to examine attitudes of hepatologists and gastroenterologists about PC for patients with ESLD. We conducted a cross-sectional survey of these specialists who provide care to patients with ESLD.

Barriers to Use of Palliative Care and Advance Care Planning Discussions for Patients With End-Stage Liver Disease.

Background & Aims: Despite evidence for the benefits of palliative care (PC) referrals and early advance care planning (ACP) discussions for patients with chronic diseases, patients with end-stage liver disease (ESLD) often do not receive such care. We sought to examine physicians' perceptions of the barriers to PC and timely ACP discussions for patients with ESLD.

Methods: We conducted a cross-sectional survey of hepatologists and gastroenterologists who provide care to adult patients with ESLD, recruited from the American Association for the Study of Liver Diseases 2018 membership registry.

PD-L1 expression, tumor mutational burden, and response to immunotherapy in patients with MET exon 14 altered lung cancers.

Background: MET exon 14 alterations are actionable oncogenic drivers. Durable responses to MET inhibitors are observed in patients with advanced MET exon 14-altered lung cancers in prospective trials. In contrast, the activity of immunotherapy, PD-L1 expression and tumor mutational burden (TMB) of these tumors and are not well characterized.

Prognosis of Patients with Cirrhosis and AKI Who Initiate RRT.

Background And Objectives: Literature on the prognosis of patients with cirrhosis who require RRT for AKI is sparse and is confounded by liver transplant eligibility. An update on outcomes in the nonlisted subgroup is needed. Our objective was to compare outcomes in this group between those diagnosed with hepatorenal syndrome and acute tubular necrosis, stratifying by liver transplant listing status.

Effects of Co-occurring Genomic Alterations on Outcomes in Patients with -Mutant Non-Small Cell Lung Cancer.

mutations occur in approximately 25% of patients with non-small cell lung cancer (NSCLC). Despite the uniform presence of mutations, patients with -mutant NSCLC can have a heterogeneous clinical course. As the pattern of co-occurring mutations may describe different biological subsets of patients with -mutant lung adenocarcinoma, we explored the effects of co-occurring mutations on patient outcomes and response to therapy.

Academic Performance on First-Year Medical School Exams: How Well Does It Predict Later Performance on Knowledge-Based and Clinical Assessments?

Number of appearances in the bottom quartile of 1st-year medical school exams were used to represent the extent to which students were having academic difficulties. Medical educators have long expressed a desire to have indicators of medical student performance that have strong predictive validity. Predictors traditionally used fell into 4 general categories: demographic (e.

Factors associated with physicians' choice of a career in research: a retrospective report 15 years after medical school graduation.

Relatively little is known regarding factors associated with the choice of a research career among practicing physicians, and most investigations of this issue have been conducted in the absence of a theoretical/conceptual model. Therefore we designed a survey to identify the determinants of decisions to pursue a biomedical research career based upon the Theory of Planned Behavior and the concept of stereotype threat. From October 2012 through January 2014 electronic surveys were sent to four consecutive Harvard Medical School graduating classes, 1996-1999.

Medical Students Who Pursue a Joint MD/MBA Degree: Who Are They and Where Are They Heading?

Increasingly, health care is being delivered in large, complex organizations, and physicians must learn to function effectively in them. As a result, several medical and business schools have developed joint programs to train physician leaders who receive both medical degree (MD) and master of business administration (MBA) degrees. We examined several themes in relation to these programs, revolving around concerns about who is attracted to them and whether exposure to the differing cultures of medicine and business have an impact on the professional identities of their graduates as manifested in their motivations, aspirations, and careers.

Processes to manage analyses and publications in a phase III multicenter randomized clinical trial.

Background: The timely publication of findings in peer-reviewed journals is a primary goal of clinical research. In clinical trials, the processes leading to publication can be complex from choice and prioritization of analytic topics through to journal submission and revisions. As little literature exists on the publication process for multicenter trials, we describe the development, implementation, and effectiveness of such a process in a multicenter trial.