Exploring clinician perspectives of systems-based practice: A physician training challenge.

Introduction: Systems-based practice (SBP) has been a competency in US graduate medical education for over 20 years, but it is not well implemented. SBP is loosely defined as physician's responsiveness to the larger system of healthcare. The aim of this study was to describe healthcare professionals' perspectives regarding: (1) their knowledge and beliefs about SBP and (2) their beliefs regarding factors in clinical learning environments (CLE) that facilitate or hinder operationalisation and learning of SBP.

Practical Tips for Undergraduate Medical Education Advisors in Residency Application Signaling.

Objectives: The residency application process has become increasingly complex for medical students and advisors to navigate. Program signaling was piloted to improve applicants' abilities to obtain interview offers at programs they were strongly interested in. The initial positive results led to expansion of signaling to additional specialties over the next two application cycles.

Fostering Students' Personal and Professional Growth: Responding to Error During the Internal Medicine Clerkship.

Objectives: Developing professionalism is critical to medical education; accordingly, professionalism curricula may be implemented longitudinally throughout undergraduate medical education. Here we share our experiences addressing student response to medical error as a component of professionalism education during the core clerkship year.

Methods: This pretest-posttest study reports medical students' knowledge regarding learning and growing in response to medical error.

Evaluating a Situational Judgment Test for Use in Medical School Admissions: Two Years of AAMC PREview Exam Administration Data.

Purpose: To examine the relationship between the Association of American Medical Colleges (AAMC) Professional Readiness Exam (PREview) scores and other admissions data, group differences in mean PREview scores, and whether adding a new assessment tool affected the volume and composition of applicant pools.

Method: Data from the 2020 and 2021 PREview exam administrations were analyzed. Two U.

The benefits of rotating through palliative care: A qualitative study.

Purpose: This is a qualitative study of written reflection projects by medical learners who completed a clinical rotation in Palliative Care (PC) at an academic tertiary care center.

Methods: Upon completing their rotation in PC, medical learners were asked to complete an open-ended reflection project that captured their overall impressions of this training and experience. Fourteen reflections were coded and analyzed.

The Financial Impact of Palliative Care and Aggressive Cancer Care on End-of-Life Health Care Costs.

Background: Medicare cancer expenditures in the last month of life have increased. Aggressive cancer care at the end-of-life (ACEOL) is considered poor quality care. We used Geisinger Health Plan (GHP) last month's costs for cancer patients who died in 2018 and 2019 to determine the costs of and influence of Palliative Care (PC) on ACEOL.

When does early palliative care influence aggressive care at the end of life?

Background: Early palliative care improves patient quality of life and influences cancer care. The time frame of early has not been established. Eight quality measures reflect aggressive care at the end of life.

The Influence of Palliative Care in Hospital Length of Stay and the Timing of Consultation.

Background: Inpatient palliative care may reduce length-of-stay, costs, mortality, and prevent readmissions. Timing of consultation may influence outcomes. The aim of this study was to explore the timing of consultation and its influences patient outcomes.

Broad Needs Assessment of Pain Education in Graduate Medical Education.

This article describes a survey-based study of graduate medical residents and fellows in an integrated health system. The study explores pain curricula, learner perspectives about pain education, and learner knowledge, attitudes, and confidence. Results indicate that pain education in the graduate medical setting is inadequate to meet learner needs.

High value care education in general surgery residency programs: A multi-institutional needs assessment.

Background: The ACGME mandates that residency programs provide training related to high value care (HVC). The purpose of this study was to explore HVC education in general surgery residency programs.

Methods: An electronic survey was distributed to general surgery residents in geographically diverse programs.

A Case of Hemorrhagic Cardiac Tamponade in a Patient with COVID-19 Infection.

• There are protean manifestations of cardiac involvement with COVID-19. • Hemorrhagic pericardial effusion may be the sole cardiac manifestation of COVID-19. • More work is required to elucidate the mechanism through which COVID-19 causes hemorrhagic pericardial effusion.

Application Factors May Not Be Predictors of Success Among General Surgery Residents as Measured by ACGME Milestones.

Background: Can factors within the Electronic Residency Application Service application be used to predict the success of general surgery residents as measured by the Accreditation Council for Graduate Medical Education (ACGME) general surgery milestones?

Methods: This is a retrospective study of 21 residents who completed training at a single general surgery residency program. Electronic Residency Application Service applications were reviewed for objective data, such as age, US Medical Licensing Examination scores, and authorship of academic publications as well as for letters of recommendation, which were scored using a standardized grading system. These factors were correlated to resident success as measured by ACGME general surgery milestone outcomes using univariate and multivariate analyses.

How Applicants to General Surgery Residency Define Resilience.

Objective: Resilience is a vital quality for the successful completion of any residency training program. Resilience is a commonly used but poorly understood term and is defined in multiple ways by people during different times of their lives. The transition from medical student to general surgical resident (GSR) is one of the most formative times in a young surgeon's professional career.

Meaningful autonomy in general surgery training: Exploring for gender bias.

Background: Resident autonomy is essential to the development of a surgical resident. This study aims to analyze gender differences in meaningful autonomy (MA) given to general surgery trainees intraoperatively.

Methods: This is a retrospective study of general surgery residents at an academic-affiliated tertiary care facility.

The Value of Surgical Graduate Medical Education (GME) Programs Within An Integrated Health Care System.

Objective: Surgical graduate medical education (GME) programs add both significant cost and complexity to the mission of teaching hospitals. While expenses tied directly to surgical training programs are well tracked, overall cost-benefit accounting has not been performed. In this study, we attempt to better define the costs and benefits of maintaining surgical GME programs within a large integrated health system.

Attitudes to out-of-programme experiences, research and academic training of gastroenterology trainees between 2007 and 2016.

Objective: Academic medical training was overhauled in 2005 after the Walport report and Modernising Medical Careers to create a more attractive and transparent training pathway. In 2007 and 2016, national web-based surveys of gastroenterology trainees were undertaken to determine experiences, perceptions of and perceived barriers to out-of-programme research experience (OOP-R).

Design Setting And Patients: Prospective, national web-based surveys of UK gastroenterology trainees in 2007 and 2016.

Stress and its causes in UK gastroenterologists: results of a national survey by the British Society of Gastroenterology.

Aim: Evaluation of stress and its causes in UK gastroenterologists.

Design: Questionnaire emailed to all 1932 medical members of the British Society of Gastroenterology.

Results: Of 567 respondents (29%), 107 (20%) graded their stress level as 4 or 5 out of 5.

Laparoscopic transhiatal esophagectomy for esophageal adenocarcinoma identified at laparoscopic Roux-en-Y gastric bypass.

Introduction: More than one third of Americans are obese. Obesity is a risk factor for gastroesophageal reflux disease (GERD) and esophageal adenocarcinoma (EA). The only durable treatment for morbid obesity and its comorbid conditions is bariatric surgery.

Tolvaptan and Neurocognitive Function in Mild to Moderate Chronic Hyponatremia: A Randomized Trial (INSIGHT).

Background: This trial assessed the effect of tolvaptan on cognition, gait, and postural stability in adult patients with mild to moderate asymptomatic hyponatremia.

Study Design: Phase 3b, multicenter, randomized, double-blind, placebo-controlled, parallel-group pilot study.

Setting & Participants: 57 men and women 50 years or older with chronic asymptomatic euvolemic or hypervolemic hyponatremia (serum sodium concentration >120-<135 mEq/L) at 16 sites.

Deprivation of both sucrose and water reduces the mosquito heart contraction rate while increasing the expression of nitric oxide synthase.

Adult female mosquitoes rely on carbohydrate-rich plant nectars as their main source of energy. In the present study we tested whether the deprivation of a carbohydrate dietary source or the deprivation of both carbohydrate and water affects mosquito heart physiology. Intravital video imaging of Anopheles gambiae showed that, relative to sucrose fed mosquitoes, the deprivation of both sucrose and water for 24h, but not the deprivation of sucrose alone, reduces the heart contraction rate.

Regional ventilation changes in severe asthma after bronchial thermoplasty with (3)He MR imaging and CT.

Purpose: To quantify regional lung ventilation in healthy volunteers and patients with severe asthma (both before and after thermoplasty) by using a combination of helium 3 ((3)He) magnetic resonance (MR) imaging and computed tomography (CT), with the intention of developing more effective image-guided treatments for obstructive lung diseases.

Materials And Methods: With approval of the local institutional review board, informed consent, and an Investigational New Drug Exemption, six healthy volunteers and 10 patients with severe asthma were imaged in compliance with HIPAA regulations by using both multidetector CT and (3)He MR imaging. Individual bronchopulmonary segments were labeled voxel by voxel from the CT images and then registered to the (3)He MR images by using custom software.

Imaging mouse lung allograft rejection with (1)H MRI.

Purpose: To demonstrate that longitudinal, noninvasive monitoring via MRI can characterize acute cellular rejection in mouse orthotopic lung allografts.

Methods: Nineteen Balb/c donor to C57BL/6 recipient orthotopic left lung transplants were performed, further divided into control-Ig versus anti-CD4/anti-CD8 treated groups. A two-dimensional multislice gradient-echo pulse sequence synchronized with ventilation was used on a small-animal MR scanner to acquire proton images of lung at postoperative days 3, 7, and 14, just before sacrifice.