-
SynthA1c: Towards Clinically Interpretable Patient Representations for Diabetes Risk Stratification.PRedictive Intelligence in MEdicine.... Oct 2023Early diagnosis of Type 2 Diabetes Mellitus (T2DM) is crucial to enable timely therapeutic interventions and lifestyle modifications. As the time available for clinical...
Early diagnosis of Type 2 Diabetes Mellitus (T2DM) is crucial to enable timely therapeutic interventions and lifestyle modifications. As the time available for clinical office visits shortens and medical imaging data become more widely available, patient image data could be used to opportunistically identify patients for additional T2DM diagnostic workup by physicians. We investigated whether image-derived phenotypic data could be leveraged in tabular learning classifier models to predict T2DM risk in an automated fashion to flag high-risk patients the need for additional blood laboratory measurements. In contrast to traditional binary classifiers, we leverage neural networks and decision tree models to represent patient data as 'SynthA1c' latent variables, which mimic blood hemoglobin A1c empirical lab measurements, that achieve sensitivities as high as 87.6%. To evaluate how SynthA1c models may generalize to other patient populations, we introduce a novel generalizable metric that uses vanilla data augmentation techniques to predict model performance on input out-of-domain covariates. We show that image-derived phenotypes and physical examination data together can accurately predict diabetes risk as a means of opportunistic risk stratification enabled by artificial intelligence and medical imaging. Our code is available at https://github.com/allisonjchae/DMT2RiskAssessment.
PubMed: 38957550
DOI: 10.1007/978-3-031-46005-0_5 -
MedEdPORTAL : the Journal of Teaching... 2024Medical schools seeking to correct and reform curricula towards anti-racist perspectives need to address anti-Black forms of racism specifically and teach students...
INTRODUCTION
Medical schools seeking to correct and reform curricula towards anti-racist perspectives need to address anti-Black forms of racism specifically and teach students critical upstander skills to interrupt manifestations of racism. We developed a course to teach preclinical medical students basic anti-racism competencies including recognition and awareness of anti-Black racism in medicine and upstander skills to advocate for patients and colleagues.
METHODS
In 2021 and 2022, we designed, implemented, and evaluated an elective course for second-year medical students ( = 149) to introduce competencies of anti-racism focusing on upstander skills for addressing anti-Blackness. We designed three patient cases and one student-centered case to illustrate manifestations of anti-Black racism in medicine and used these cases to stimulate small-group discussions and guide students toward recognizing and understanding ways of responding to racism. We designed pre- and postassessments to evaluate the effectiveness of the course and utilized anonymous feedback surveys.
RESULTS
Participants showed significant improvement in pre- to postassessment scores in both years of the course. The anonymous feedback survey showed that 97% of students rated the course at least somewhat effective, and the qualitative responses revealed five core themes: course timing, case complexity, learner differentiation, direct instruction, and access to resources.
DISCUSSION
This course reinforces upstander competencies necessary for advancing anti-racism in medicine. It addresses a gap in medical education by reckoning with the entrenched nature of anti-Black racism in the culture of medicine and seeks to empower undergraduate medical students to advocate for Black-identifying patients and colleagues.
Topics: Humans; Racism; Education, Medical, Undergraduate; Curriculum; Students, Medical; Surveys and Questionnaires; Clinical Competence
PubMed: 38957536
DOI: 10.15766/mep_2374-8265.11395 -
MedEdPORTAL : the Journal of Teaching... 2024Medication errors can lead to significant adverse events. Nearly 50% of medication errors occur during the prescription-writing stage of the medication use process, and...
INTRODUCTION
Medication errors can lead to significant adverse events. Nearly 50% of medication errors occur during the prescription-writing stage of the medication use process, and effective interprofessional collaboration and communication are key to reducing error in this process.
METHODS
We developed a three-part, 60-minute, interprofessional education activity providing medical, physician assistant, and pharmacy students the opportunity to practice collegial interprofessional communication surrounding prescribing practices. Learners met virtually initially as a large group and divided into small groups facilitated by a health professional. Part 1 involved reviewing two prescriptions prepared by learners; part 2 was a discussion about the education, roles, and responsibilities of each profession; and part 3 focused on identifying prescription errors in examples provided by faculty. Students completed a post-pre survey measuring their perception of learning the Interprofessional Collaborative Competency Attainment Survey (ICCAS) areas.
RESULTS
Of 317 participants (151 doctor of osteopathy, 68 master of physician assistant studies, and 98 doctor of pharmacy students), 286 completed the post-pre survey, for a 90% response rate. Students reported statistically significant ( < .001) increases in all 20 questions spanning the six ICCAS areas.
DISCUSSION
The virtual format allowed multiple institutions to participate from various locations. It broadened the learners' experience by fostering interaction among those with varied perspectives and allowed collaboration between locations and programs that otherwise could not have participated. The activity introduced students to virtual collaboration and key telehealth skills, enhancing their confidence and familiarity with virtual interactions in a professional setting.
Topics: Humans; Physician Assistants; Surveys and Questionnaires; Interprofessional Relations; Cooperative Behavior; Interprofessional Education; Medication Errors; Students, Pharmacy; Clinical Competence; Education, Pharmacy; Osteopathic Medicine; Drug Prescriptions
PubMed: 38957535
DOI: 10.15766/mep_2374-8265.11403 -
MedEdPORTAL : the Journal of Teaching... 2024Physicians can be unaware that many US adults have intermediate or lower health literacy. Avoiding medical jargon in patient communication can improve poor outcomes...
INTRODUCTION
Physicians can be unaware that many US adults have intermediate or lower health literacy. Avoiding medical jargon in patient communication can improve poor outcomes associated with lower health literacy, but physicians may struggle to do so as health literacy education is neither standardized nor universal at US allopathic medical schools. As with other skills-based proficiencies in medical education, repeat exposure and active learning help build competency. Medical students developed the Patient Communication Challenge (PCC), an adaptation of the Hasbro game Taboo, to facilitate practice of patient-centered communication skills among medical trainees.
METHODS
Hour-long workshops were held for groups of preclinical medical students. Students watched a communication exemplar video, played the PCC game, and completed a postworkshop survey. To play, two teams competed to earn points by identifying medical concepts as explained by a teammate who described the term without using medical jargon.
RESULTS
Evaluations indicated that the game was enjoyable and reinforced didactic concepts through active learning, with self-reported participant satisfaction and competency gain. Overall, 59% of participants (53 of 90) completed postworkshop surveys; 91% (48 of 53) agreed they felt more proficient in avoiding jargon, 94% (50 of 53) would recommend the workshop to a classmate, and 100% (53 of 53) would play again.
DISCUSSION
The PCC can help early medical trainees develop health communication skills through gamification with utilization of adult learning principles and adequate frequency for skill retention. Future applications include longitudinal assessment and expanding to later stages of medical training and other health professions.
Topics: Humans; Students, Medical; Communication; Surveys and Questionnaires; Video Games; Education, Medical, Undergraduate; Physician-Patient Relations; Problem-Based Learning
PubMed: 38957534
DOI: 10.15766/mep_2374-8265.11411 -
MedEdPORTAL : the Journal of Teaching... 2024Without explicit education and training on how social determinants of health (SDoH) impact patient care and health outcomes, medical schools are failing to effectively...
INTRODUCTION
Without explicit education and training on how social determinants of health (SDoH) impact patient care and health outcomes, medical schools are failing to effectively equip future physicians to serve their patients. We created this workshop on health equity with a focus on SDoH to help students more effectively communicate with diverse populations.
METHODS
Third-year medical students and faculty were provided with class guides, learning objectives, role-play vignettes containing clerkship-specific history and physical exams, schedules, and discussion questions during a 2-hour session centered on SDoH. The workshop's impact was measured through mixed-methods analysis of surveys.
RESULTS
Based on pre- and postsurvey results from 87 participants, medical students strongly agreed that (1) SDoH factor more into a patient's health outcomes than the clinical encounter (pre: 67%, post: 87%), (2) it is their duty to gather information about SDoH (pre: 86%, post: 97%), (3) neighborhood safety is one of the key SDoH (pre: 88%, post: 97%), (4) they understood the impact of upstream interventions (pre: 35%, post: 93%), (5) they could efficiently screen all patients for SDoH at every medical encounter (pre: 27%, post: 86%), and (6) they could find preliminary resources to quickly assist patients in need of help regarding particular SDoH (pre: 26%, post: 85%).
DISCUSSION
This was the first iteration of this workshop; challenges involved piloting the content, time restraints, and organizational structure of the workshop design. Future directions include making SDoH curricula an integral part of undergraduate medical education and diverse clinical environments.
Topics: Humans; Social Determinants of Health; Students, Medical; Surveys and Questionnaires; Education, Medical, Undergraduate; Curriculum; Education; Male; Female
PubMed: 38957525
DOI: 10.15766/mep_2374-8265.11402 -
MedEdPORTAL : the Journal of Teaching... 2024Patient encounters perceived to be challenging are common and contribute to both suboptimal patient health outcomes and provider burnout. A trauma-informed care (TIC)...
INTRODUCTION
Patient encounters perceived to be challenging are common and contribute to both suboptimal patient health outcomes and provider burnout. A trauma-informed care (TIC) approach to these encounters is critical, as many of the characteristics associated with challenging patient encounters can be linked to a history of trauma exposure.
METHODS
Our team created and delivered a 1-hour synchronous virtual session intended to bolster provider knowledge of TIC principles and their application to challenging adolescent encounters. Participants were all faculty and staff engaged in pediatric primary care at an urban academic center, including physicians, nurse practitioners, psychologists, and social workers. The content was rooted in adult learning principles and included didactic components anchored to case-based learning with facilitated group discussions and opportunities for reflection. We used paired pre- and postsession self-assessments of provider knowledge, confidence, and practice related to TIC using Likert-scale and free-text questions. Descriptive statistics and a paired test were used to determine the impact of the session on these metrics.
RESULTS
In 24 paired surveys, there were statistically significant increases ( ≤ .001) in participant perceived knowledge, confidence, and practice, with 100% of participants having a statistically significant improvement in one or more of these domains. There were also strongly positive Likert-scale and free-text responses regarding content relevance and delivery.
DISCUSSION
We demonstrate that a brief session can create improvement in pediatric providers' perceived knowledge about the application of TIC principles to challenging adolescent encounters as well as confidence in their ability to put these into practice.
Topics: Humans; Adolescent; Surveys and Questionnaires; Pediatricians; Staff Development; Female; Male; Pediatrics; Wounds and Injuries
PubMed: 38957524
DOI: 10.15766/mep_2374-8265.11408 -
MedEdPORTAL : the Journal of Teaching... 2024Medical curricula implicitly teach that race has a biological basis. Clinical rotations reinforce this misconception as race-based algorithms are used to guide clinical...
INTRODUCTION
Medical curricula implicitly teach that race has a biological basis. Clinical rotations reinforce this misconception as race-based algorithms are used to guide clinical decision-making. This module aims to expose the fallacy of race in clinical algorithms, using the estimated glomerular filtration rate (eGFR) equation as an example.
METHODS
We created a 60-minute module in consultation with nephrologists. The format was an interactive, case-based presentation with a didactic section. A third-year medical student facilitated the workshops to medical students. Evaluation included pre/post surveys using 5-point Likert scales to assess awareness regarding use of race as a biological construct. Higher scores indicated increased awareness.
RESULTS
Fifty-five students participated in the module. Pre/post results indicated that students significantly improved in self-perceived knowledge of the history of racism in medicine (2.6 vs. 3.2, < .001), awareness of race in clinical algorithms (2.7 vs. 3.7, < .001), impact of race-based eGFR on quality of life/treatment outcomes (4.5 vs. 4.8, = .01), differences between race and ancestry (3.7 vs. 4.3, < .001), and implications of not removing race from the eGFR equation (2.7 vs. 4.2, < .001). Students rated the workshops highly for quality and clarity.
DISCUSSION
Our module expands on others' work to expose the fallacy of race-based algorithms and define its impact on health equity. Limitations include a lack of objective assessment of knowledge acquisition. We recommend integrating this module into preclinical and clinical curricula to discuss the use of race in medical literature and clinical practice.
Topics: Humans; Students, Medical; Algorithms; Curriculum; Glomerular Filtration Rate; Surveys and Questionnaires; Racial Groups; Education, Medical, Undergraduate; Male; Racism; Female
PubMed: 38957523
DOI: 10.15766/mep_2374-8265.11412 -
ATS Scholar Jun 2024
PubMed: 38957496
DOI: 10.34197/ats-scholar.2023-0105BR -
ATS Scholar Jun 2024A lack of high-quality provider education hinders the delivery of standard-of-care delirium detection and prevention practices in the intensive care unit (ICU). To fill...
BACKGROUND
A lack of high-quality provider education hinders the delivery of standard-of-care delirium detection and prevention practices in the intensive care unit (ICU). To fill this gap, we developed and validated an e-learning ICU Delirium Playbook consisting of eight videos and a 44-question knowledge assessment quiz. Given the increasing Spanish-speaking population worldwide, we translated and cross-culturally adapted the playbook from English into Spanish.
OBJECTIVE
To translate and culturally adapt the ICU Delirium Playbook into Spanish, the second most common native language worldwide.
METHODS
The translation and cross-cultural adaptation process included double forward and back translations and harmonization by a 14-person interdisciplinary team of ICU nurses and physicians, delirium experts, methodologists, medical interpreters, and bilingual professionals representing many Spanish-speaking global regions. After a preeducation quiz, a nurse focus group completed the playbook videos and posteducation quiz, followed by a semistructured interview.
RESULTS
The ICU Delirium Playbook: Spanish Version maintained conceptual equivalence to the English version. Focus group participants posted mean (standard deviation) pre- and post-playbook scores of 63% (10%) and 78% (12%), with a 15% (11%) pre-post improvement ( = 0.01). Participants reported improved perceived competency in performing the Confusion Assessment Method for the ICU and provided positive feedback regarding the playbook.
CONCLUSION
After translation and cultural adaptation, the ICU Delirium Playbook: Spanish Version yielded significant knowledge assessment improvements and positive feedback. The Spanish playbook is now available for public dissemination.
PubMed: 38957494
DOI: 10.34197/ats-scholar.2023-0114OC -
ATS Scholar Jun 2024
PubMed: 38957490
DOI: 10.34197/ats-scholar.2023-0119BR