Bringing back the core concepts of physiology in an advanced medical school senior elective.

Integrating physiology core concepts into the clinical years of medical education has been challenging despite efforts. This article describes a fourth-year medical school elective, Advanced Physiology in Critical Care Medicine, that focused on integrating physiology core concepts in a case-based learning approach. The elective used interdisciplinary faculty in a virtual forum.

Exploring students' [pre-pandemic] use and the impact of commercial-off-the-shelf learning platforms on students' national licensing exam performance: A focused review - BEME Guide No. 72.

Background: Commercial-off-the-shelf learning platforms developed for medical education (herein referred to as MedED-COTS) have emerged as a resource used by a majority of medical students to prepare for licensing examinations. As MedED-COTS proliferate and include more functions and features, there is a need for an up-to-date review to inform medical educators on (a) students' use of MedED-COTS outside the formal medical school curriculum, (b) the integration of MedED-COTS into the formal curriculum, and (c) the potential effects of MedED-COTS usage on students' national licensing exam scores in the USA.

Methods: Due to the limited number of studies published on either the use or integration of MedED-COTS, a focused review of literature was conducted to guide future research and practice.

Determining Grades in the Internal Medicine Clerkship: Results of a National Survey of Clerkship Directors.

Purpose: Trust in and comparability of assessments are essential in clerkships in undergraduate medical education for many reasons, including ensuring competency in clinical skills and application of knowledge important for the transition to residency and throughout students' careers. The authors examined how assessments are used to determine internal medicine (IM) core clerkship grades across U.S.

Fostering productive conversations in a Kenyan tertiary intensive care unit: lessons learnt.

Effective communication remains key in delivery of comprehensive care to patient especially in the intensive care unit (ICU) setting. However, many providers, for various reasons, struggle with the art of effective communication adversely affecting relationship with patients and their families. Little is known or has been published about effective communication in ICUs within sub-Saharan Africa.

Reforming the 4th-Year Curriculum as a Springboard to Graduate Medical Training: One School's Experiences and Lessons Learned.

Problem: Concerns regarding the quality of training in the 4th year of medical school and preparation of graduates to enter residency education persist and are borne out in the literature.

Intervention: We reviewed the published literature regarding Year 4 concerns as well as institutional efforts to improve the 4th-year curriculum from several schools. Based on input from key stakeholders, we established 4 goals for our Year 4 curriculum reform: (a) standardize the curricular structure, (b) allow flexibility and individualization, (c) improve the preparation for residency, and (d) improve student satisfaction.

Effect of bedside physical diagnosis training on third-year medical students' physical exam skills.

Background: Graduating medical students, when surveyed, noted a deficit in training in physical examination skills.

Purposes: In an attempt to remedy this deficit we implemented a pilot program for 3rd-year medical students consisting of twice-weekly bedside diagnosis rounds as part of their 8-week medicine clerkship.

Methods: To assess the success of this program we reviewed students' objective structured clinical exam (OSCE) scores at the completion of the clerkship compared with prior years' students who did not have the bedside physical diagnosis training.

Evaluation of housestaff knowledge and perception of competence in palliative symptom management.

Purpose: The Accreditation Council for Graduate Medical Education requires that internal medicine (IM) core curricula include end-of-life care and pain management concepts and that fellows in hematology/oncology, pulmonary/critical care, and geriatrics should receive formal instruction and clinical experience in palliative and end-of-life care. We aimed to assess the effectiveness of current teaching methods for housestaff in these fields.

Method: All of the IM residents, geriatric medicine fellows, hematology/oncology fellows, and pulmonary/critical care fellows from four regional graduate medical education sites were asked to participate in an online survey at the beginning and end of the 2008-2009 academic year.

Humidification and secretion volume in mechanically ventilated patients.

Objective: To determine potential effects of humidification on the volume of airway secretions in mechanically ventilated patients.

Methods: Water vapor delivery from devices providing non-heated-wire humidification, heated-wire humidification, and heat and moisture exchanger (HME) were quantified on the bench. Then, patients requiring 24-hour mechanical ventilation were exposed sequentially to each of these humidification devices, and secretions were removed and measured by suctioning every hour during the last 4 hours of the 24-hour study period.

American College of Chest Physicians consensus statement on the respiratory health effects of asbestos. Results of a Delphi study.

Background: The diagnosis of and criteria for the evaluation of asbestos-related disease impairment remains controversial after decades of research. Assessing agreement among experts who study pneumoconiosis, and diagnose and treat patients with asbestos-related respiratory conditions may be the first step in clarifying clinical and forensic/administrative issues associated with asbestos-related pulmonary conditions.

Methods: We conducted a Delphi study, an iterative method of obtaining consensus among a group of experts.

Y-piece temperature and humidification during mechanical ventilation.

Background: Practitioners often presume there is adequate humidification in the ventilator circuit if the Y-piece is at a specified temperature, but control of Y-piece temperature may be inadequate to ensure adequate humidification.

Methods: In an in vitro bench model we measured water-vapor delivery with several heated humidification setups and a wide range of minute volume (V (E)) values. The setup included a condenser, hygrometry, and thermometer.

Diagnosis and management of work-related asthma: American College Of Chest Physicians Consensus Statement.

Background: A previous American College of Chest Physicians Consensus Statement on asthma in the workplace was published in 1995. The current Consensus Statement updates the previous one based on additional research that has been published since then, including findings relevant to preventive measures and work-exacerbated asthma (WEA).

Methods: A panel of experts, including allergists, pulmonologists, and occupational medicine physicians, was convened to develop this Consensus Document on the diagnosis and management of work-related asthma (WRA), based in part on a systematic review, that was performed by the University of Alberta/Capital Health Evidence-Based Practice and was supplemented by additional published studies to 2007.

Aerosolized antibiotics and ventilator-associated tracheobronchitis in the intensive care unit.

Context: In critically ill intubated patients, signs of respiratory infection often persist despite treatment with potent systemic antibiotics.

Objective: The purpose of this study was to determine whether aerosolized antibiotics, which achieve high drug concentrations in the target organ, would more effectively treat respiratory infection and decrease the need for systemic antibiotics.

Design: Double-blind, randomized, placebo-controlled study performed from 2003 through 2004.

Use of the All Patient Refined-Diagnosis Related Group (APR-DRG) Risk of Mortality Score as a Severity Adjustor in the Medical ICU.

Objective: To evaluate the performance of APR-DRG (All Patient Refined-Diagnosis Related Group) Risk of Mortality (ROM) score as a mortality risk adjustor in the intensive care unit (ICU).

Design: Retrospective analysis of hospital mortality.

Setting: Medical ICU in a university hospital located in metropolitan New York.

Flock workers' exposures and respiratory symptoms in five plants.

Background: Sentinel cases of lymphocytic bronchiolitis in flock production and coating operations triggered a five-plant study of airborne respirable dust and fiber exposures and health symptoms.

Methods: Job histories from 219 current workers were linked to a job-exposure matrix derived from personal exposure measurements of respirable dust and fibers. Univariate group comparisons and multivariate modeling tested for relations between indices of cumulative and current exposure, and respiratory and systemic symptom outcomes.

Genetic factors and asthma in aluminum smelter workers.

An asthma-like condition has been reported among aluminum smelter potroom workers. The pathophysiologic mechanisms and the causative agent involved are unknown. Inasmuch as gene polymorphisms are associated with asthma in the general population, the authors of this case-control study examined whether polymorphisms were associated with the development of potroom asthma.

Crab allergen exposures aboard five crab-processing vessels.

Aerosolized crab allergens are suspected etiologic agents for asthma among crab-processing workers. The objectives of this study were to characterize crab allergen concentrations and respiratory symptom prevalence among processing workers aboard crab-processing vessels. A cross-sectional survey of five crab-processing vessels was conducted near Dutch Harbor, Alaska.