Early career outcomes of a large four-year MD/ MPH program: Results of a cross sectional survey of three cohorts of graduates.

The University of Miami Miller School of Medicine started a four-year MD/ MPH program in 2011 with a mission to graduate public health physician leaders to address the public health needs of the 21st century, with emphasis on three areas: leadership, research, and public health. A prospective cross-sectional survey of early graduates was conducted to understand how they incorporate public health training into their careers. There were two study questions: What are the self-described early career activities of the graduates of the first three cohorts in the areas of leadership, research, and public health and what are the perceptions regarding the influence of the public health training on their careers? In the summer of 2020, a survey was sent to graduates from the classes of 2015, 2016, and 2017. In addition to several multiple-choice questions, the survey included an open-ended question on the impact of public health training in their careers. Inductive content analysis was used to analyze the responses to the open-ended question. Eighty-two of the 141 eligible graduates (63%) completed the survey; 80 of whom had participated or was currently participating in residency training. Forty-nine joined a residency in a primary care field. Many graduates had leadership roles in their early careers, including 35 who were selected as chief residents. Fifty-seven participated in research, most commonly in quality improvement (40), clinical (34) and community based (19). Over one third (30) chose to do work in public health during residency. Themes that emerged regarding the influence of public health training on their careers were: 1) Shifts in perspective, 2) Value of specific skills related to public health, 3) Steppingstone for professional opportunities 4) Focus on health disparities, social determinants, and inadequacies of the healthcare system, 5) Perception as leaders and mentors for peers, and 6) Preparedness for the pandemic. Graduates self-reported involvement in leadership, research, and public health activities as well as a commitment towards addressing some of our most pressing public health needs. Although long-term career outcomes need to be determined over time, graduates currently report considerable benefits of their public health training for their professional outcomes.

EPMO: A novel medical student assessment tool that integrates entrustable professional activities, prime, and the modified Ottawa coactivity scale.

PURPOSE: Alignment of workplace-based assessments (WPBA) with core entrustable professional activities (EPAs) for entering residency may provide opportunities to monitor student progress across the continuum of undergraduate medical education. Core EPAs, however, reflect tasks of varying degrees of difficulty and faculty assessors are not accustomed to rating students based on entrustability. Expectations of student progress should vary depending on the complexity of the tasks associated with the EPAs. An assessment tool that orients evaluators to the developmental progression of specific EPA tasks will be critical to fairly evaluate learners. METHODS: The authors developed an EPA assessment tool combining the frameworks of Professionalism, Reporter, Interpreter, Manager, Educator (PRIME), and Modified Ottawa coactivity scales. Only those EPAs that could be repeatedly observed and assessed across clinical clerkships were included. From July 2019 to March 2020, third-year medical students across multiple clerkships were assessed using this tool. The authors hypothesized that if the tool was applied correctly, ratings of learner independence would be lower with higher complexity tasks and that such ratings would increase over the course of year with ongoing clinical learning. RESULTS: Assessment data for 247 medical students were similar across clerkships suggesting that evaluators in diverse clinical contexts were able to use this tool to assign scores reflective of developing entrustability in the workplace. Faculty rated student entrustability highest in skills emphasized in the pre-clerkship curriculum (professionalism and reporter) and progressively lower in more advanced skills (interpreter and manager). Students' ratings increased over time with more clinical exposure. CONCLUSIONS: The authors developed a composite WBPA tool that combines the frameworks of EPAs, PRIME, and Modified Ottawa Co- Activity and demonstrated the usability of applying it for learner assessments in clinical settings. Further multicenter studies with cohorts of pre- and post-clerkship students may provide additional validity evidence for the tool.

The Impact of Internal Medicine Clerkship Characteristics and NBME Subject Exams on USMLE Step 2 Clinical Knowledge Exam Performance.

BACKGROUND: Residency program directors will likely emphasize the United States Medical Licensing Exam (USMLE) Step 2 clinical knowledge (CK) exam more during residency application given the recent USMLE Step 1 transition to pass/fail scoring. We examined how internal medicine clerkship characteristics and NBME subject exam scores affect USMLE Step 2 CK performance. DESIGN: The authors used univariable and multivariable generalized estimating equations to determine associations between Step 2 CK performance and internal medicine clerkship characteristics and NBME subject exams. The sample had 21,280 examinees' first Step 2 CK scores for analysis. RESULTS: On multivariable analysis, Step 1 performance (standardized ß = 0.45, p < .001) and NBME medicine subject exam performance (standardized ß = 0.40, p < .001) accounted for approximately 60% of the variance in Step 2 CK performance. Students who completed the internal medicine clerkship last in the academic year scored lower on Step 2 CK (Mdiff = -3.17 p < .001). Students who had a criterion score for passing the NBME medicine subject exam scored higher on Step 2 CK (Mdiff = 1.10, p = .03). There was no association between Step 2 CK performance and other internal medicine clerkship characteristics (all p > 0.05) nor with the total NBME subject exams completed (ß=0.05, p = .78). CONCLUSION: Despite similarities between NBME subject exams and Step 2 CK, the authors did not identify improved Step 2 CK performance for students who had more NBME subject exams. The lack of association of Step 2 CK performance with many internal medicine clerkship characteristics and more NBME subject exams has implications for future clerkship structure and summative assessment. The improved Step 2 CK performance in students that completed their internal medicine clerkship earlier warrants further study given the anticipated increase in emphasis on Step 2 CK.

Developing Awareness and Allies: Simulating Difficult Conversations about Microaggressions for Faculty and Students.

OBJECTIVES: Discrimination and bias in clinical training often take the form of microaggressions, which, albeit unintentional, are detrimental to the learning environment and well-being of students. Although there are a few reports of medical schools training students to respond to microaggressions, none have included a complementery student-led faculty training module. The aim of this study was to develop and evaluate a case-based approach to improving student resilience and increasing faculty awareness of microaggressions in the clinical setting. METHODS: We created four realistic cases of microaggressions and uncomfortable conversations, based on students' experiences on the wards, to implement training for incoming third-year students and their core faculty. Standardized patients were trained to effectively portray discriminatory faculty, residents, and patients. Institutional review board-approved surveys were administered and statistically analyzed to evaluate for efficacy. RESULTS: Students had greater mean confidence scores for responding to microaggressions immediately and at 6 months after the sessions (P < 0.05). Faculty showed improved mean confidence and understanding of the definition of a microaggression (P < 0.05). CONCLUSIONS: This approach had results similar to other studies, with the additional benefit of training faculty with the same scenarios. We believe that this method helped bridge the gap between students' notions of discrimination and faculty understanding of microaggressions.

Characteristics of academic medicine change agents as revealed by 4th-year medical students' reflections-on-practice.

PROBLEM: At present, formal training in adult learning principles, educational theories, and educational methods is not a core objective of most medical school curricula. As academic medical centers aim to develop the next generation of medical educators, students must be provided an opportunity to learn educational principles, engage in supervised teaching activities, and develop experiences in academic medicine to foster interest early in their development as educators. INTERVENTION: We developed a longitudinal medical education elective for fourth-year medical students, which was comprised of attending five seminars, leading 15 teaching sessions, formulating a medical education project, and writing a reflective essay. The seminars covered the history of medical education in the USA, adult learning theory and teaching principles, use of various teaching strategies and formats, construction and organization of curricula, effective models of evaluation and feedback provision, and principles of educational research. CONTEXT: This exploratory quasi-experiment incorporated a concurrent mixed methods data collection approach via pre- and post-seminar surveys and narrative reflection essay document analyses. IMPACT: Learners revealed favorable changes in their self-efficacy and self-perceived knowledge and attitudes towards medical education. A qualitative analysis of the reflective essays revealed five thematic categories (learning impacts, medical educator growth, leadership growth, medical school reflections, and future professional plans) and thirteen sub-categories. Students found many opportunities to implement high-quality educational projects, expressed commitment to pursuing teaching careers, and felt better equipped to assume a leadership role as change agents in academic medicine. LESSONS LEARNED: Findings are likely relevant to critical stakeholders who advocate for the inclusion of formal educational skills training into medical education curricula.

Impact of Visual Thinking Strategies (VTS) on the Analysis of Clinical Images: A Pre-Post Study of VTS in First-Year Medical Students.

To assess the effectiveness of Visual Thinking Strategies (VTS) in medical education curricula, a pretest-posttest experimental study design was used to evaluate the impact of participating in VTS workshops on first-year medical students. A total of forty-one intervention and sixty comparative students completed the study which included the analysis of clinical images followed by a measurement of word count, length of time analyzing images, and quality of written observations of clinical images. VTS training increased the total number of words used to describe clinical images, the time spent analyzing the images, and the number of clinically relevant observations.

Synchronous metaplastic breast carcinoma and lung adenocarcinoma: a rare case and review of the literature.

Synchronous primary cancers occur in 1.7% of breast cancer cases and metaplastic breast cancer (MBC) occurs in less than 1% of breast cancer cases. We present a previously healthy 66-year-old woman diagnosed with MBC after surgical resection of a presumed cyst. A second primary cancer, multifocal lung adenocarcinoma, was discovered during the staging process for her MBC. Remarkably she had not experienced pulmonary or constitutional symptoms at the time of diagnosis. She received chemotherapy with paclitaxel and carboplatin, followed by immunotherapy with nivolumab. At 24 months of follow-up after her initial diagnosis, she was breast cancer-free with stable pulmonary nodules. This case highlights that rather than assuming multifocal lesions represent metastasis, biopsies should be considered as clinical management could be significantly altered in the presence of a synchronous cancer. Furthermore, platinum-based chemotherapy agents have potential to be considered in the treatment of MBC.

Which Internal Medicine Clerkship Characteristics Are Associated With Students' Performance on the NBME Medicine Subject Exam? A Multi-Institutional Analysis.

PURPOSE: To identify which internal medicine clerkship characteristics may relate to NBME Medicine Subject Examination scores, given the growing trend toward earlier clerkship start dates. METHOD: The authors used linear mixed effects models (univariable and multivariable) to determine associations between medicine exam performance and clerkship characteristics (longitudinal status, clerkship length, academic start month, ambulatory clinical experience, presence of a study day, involvement in a combined clerkship, preclinical curriculum type, medicine exam timing). Additional covariates included number of NBME clinical subject exams used, number of didactic hours, use of a criterion score for passing the medicine exam, whether medicine exam performance was used to designate clerkship honors, and United States Medical Licensing Examination Step 1 performance. The sample included 24,542 examinees from 62 medical schools spanning 3 academic years (2011-2014). RESULTS: The multivariable analysis found no significant association between clerkship length and medicine exam performance (all pairwise P > .05). However, a small number of examinees beginning their academic term in January scored marginally lower than those starting in July (P < .001). Conversely, examinees scored higher on the medicine exam later in the academic year (all pairwise P < .001). Examinees from schools that used a criterion score for passing the medicine exam also scored higher than those at schools that did not (P < .05). Step 1 performance remained positively associated with medicine exam performance even after controlling for all other variables in the model (P < .001). CONCLUSIONS: In this sample, the authors found no association between many clerkship variables and medicine exam performance. Instead, Step 1 performance was the most powerful predictor of medicine exam performance. These findings suggest that medicine exam performance reflects the overall medical knowledge students accrue during their education rather than any specific internal medicine clerkship characteristics.

SVI Self-Study Guide: A Study Tool for Independent Preparation for the AAMC Standardized Video Interview.

Introduction: Since 2017, students applying to emergency medicine residencies must take the AAMC Standardized Video Interview (SVI) to assess their knowledge of professional behaviors and interpersonal and communication skills. Due to the SVI's novelty, there are not many study tools available to prepare for it, outside of the resources provided by the AAMC. Methods: The SVI Self-Study Guide is a PowerPoint document that learners can use to prepare for the SVI independently. It is intended for fourth-year medical students who are applying to emergency medicine residencies and therefore planning to take the SVI. The guide was distributed via email and assessed with a pre- and postquiz measuring subjective feelings of preparedness as well as testing knowledge of professionalism and interpersonal and communication skills. Results: Eleven students were invited to use the SVI Self-Study Guide, of whom 10 and eight took the pre- and postquiz, respectively. There was a statistically significant increase in learners' self-rated feelings of preparedness to take the SVI (p < .05). Although there was no significant change in the average score on four knowledge-based questions (p = .29), the average score increased from 72.50% to 93.25%. Discussion: Overall, there was a higher improvement in feelings of preparedness to take the SVI than in performance on knowledge-based questions. This suggests that learners benefited the most from practicing using the SVI testing format. The SVI Self-Study Guide can be distributed via email to supplement existing resources in preparing for the SVI.

Antimicrobial properties of CuO nanorods and multi-armed nanoparticles against B. anthracis vegetative cells and endospores.

Two different kinds of CuO nanoparticles (NPs) namely CuO nanorods (PS2) and multi-armed nanoparticles (P5) were synthesized by wet and electrochemical routes, respectively. Their structure, morphology, size and compositions were characterized by SEM, EDX and XRD. The NPs demonstrated strong bactericidal potential against Bacillus anthracis cells and endospores. PS2 killed 92.17% of 4.5 × 10(4) CFU/mL B. anthracis cells within 1 h at a dose of 1 mg/mL. Whereas P5 showed a higher efficacy by killing 99.92% of 7 × 10(5) CFU/mL B. anthracis cells within 30 min at a dose of 0.5 mg/mL and 99.6% of 1.25 × 10(4) CFU/mL B. anthracis cells within 5 min at a dose of 2 mg/mL. More than 99% of spores were killed within 8 h with 2 mg/mL PS2 in LB media.

Surface plasmon resonance characterization of monoclonal and polyclonal antibodies of malaria for biosensor applications.

Surface plasmon resonance (SPR) screening of monoclonal and polyclonal antibodies of Plasmodium falciparum (MoabPf and PoabPf) for recombinant Histidine rich protein-II antigen (Ag) of Pf (rHRP-II Ag) was conducted in a real-time and label-free manner to select an appropriate antibody (Ab) for biosensor applications. In this study 4-mercaptobenzoic acid (4-MBA) modified gold SPR chip was used for immobilizing the Ag and then Ab was interacted. SEM image showed modification of SPR chip with 4-MBA and EDAX confirmed the presence of 4-MBA on the SPR chip. Equilibrium constant (KD) and maximum binding capacity of analyte (Bmax) values for the interaction of MoabPf or PoabPf with the immobilized rHRP-II Ag were calculated and found to be 0.517 nM and 48.61 m° for MoabPf and 2.288 nM and 46.80 m° for PoabPf, respectively. In addition, thermodynamic parameters such as ΔG, ΔH and ΔS were determined for the interaction between rHRP-II Ag and MoabPf or PoabPf and the values revealed that the interaction is spontaneous, exothermic and driven by entropy. The kinetics and thermodymanic results of this study revealed that the interaction between MoabPf and rHRP-II Ag is more effective than that of PoabPf due to the fact that MoabPf was derived from a single epitope (single clone) whereas the PoabPf was from the mixture of a number of epitopes (polyclones). Finally, SPR methodology was developed for the sensing of malarial antibodies. The limit of detection was found to be 5.6 pg with MoabPf which was found to be the best in our study.

Teaching health advocacy to medical students: a comparison study.

CONTEXT: Many encourage service learning and health advocacy training in medical student education, but related evaluation is limited. OBJECTIVES: To assess (1) impact of a required community health advocacy training for medical students on student attitudes, knowledge, and skills; (2) student characteristics associated with higher advocacy knowledge and skills; and (3) perspectives of community-based organizations (CBOs). DESIGN: Cross-sectional surveys. SETTING: University of Miami Miller School of Medicine (UMMSM) Regional Medical Campus and main campus. PARTICIPANTS: Medical students at both UMMSM campuses. INTERVENTION: Required community health advocacy training for first- and second-year students including classroom experiences and hands-on project in partnership with a CBO. MAIN OUTCOME MEASURES: Student characteristics, health advocacy-related attitudes, self-reported and objective knowledge, and skills. Scores were compared between campuses, with multivariable modeling adjusting for individual student characteristics. Community-based organization perspectives were assessed via separate surveys. RESULTS: Ninety-eight (77%) regional campus students (intervention group) and 139 (30%) main campus students (comparison group) completed surveys. Versus the comparison group, the intervention group reported greater: mean knowledge of community health needs: 34.6 versus 31.1 (range: 11-44, P < .01), knowledge about CBOs: 3.0 versus 2.7 (range 1-4, P < .01) and knowledge of community resources: 5.4 versus 2.3 (range, 0-11, P < .01), and mean skill scores: 12.7 versus 10.5 (score range: 4-16, P < .01), following the intervention. Using adjusted analysis across both groups, female gender was associated with higher attitudes score. High level of previous community involvement was associated with higher attitude and skill scores. Higher self-reported educational debt was associated with higher skill scores. Community-based organization perspectives included high satisfaction and a desire to influence the training of future physicians. CONCLUSIONS: Medical student advocacy training in partnership with community-based organizations could be beneficial in improving student advocacy knowledge and skills in addressing community health issues and in developing sustainable community partnerships.

Lessons learned during an in-flight medical emergency: case report and discussion.

The following case report details an in-flight medical emergency (IFME) that occurred during a trans-continental flight while the authors were en route to a medical conference. The report highlights the necessity for an improved approach to the prevention and management of IFMEs.

Monoclonal antibodies against recombinant histidine-rich protein 2 of Plasmodium falciparum and their use in malaria diagnosis.

Histidine-rich protein-2 (HRPII) secreted by Plasmodium falciparum finds its use as a compelling marker in malaria diagnosis and follow-up. Monoclonal antibodies (MAbs) against P. falciparum HRPII are widely used in antibody-based diagnostic systems to detect HRPII protein in blood of malaria-suspected individuals. In this study, a set of five monoclonal antibodies against recombinant HRPII (rHRPII) were generated and assessed for their potential in diagnostics. Three among the five generated MAbs were of IgG1 isotype and the remaining were of IgM isotype. Probing the MAbs against proved P. falciparum infected serum and pooled control sera by immunoblotting revealed that the MAbs were successful in exposing malarial infection. Collectively, the generated MAbs have the potential to be used in immuno-based diagnostic systems uncovering P. falciparum infections.

Amperometric immunosensor based on gold nanoparticles/alumina sol-gel modified screen-printed electrodes for antibodies to Plasmodium falciparum histidine rich protein-2.

We report herein the amperometric immunosensor for antibodies to Plasmodium falciparum histidine rich protein-2 (PfHRP-2). Screen-printed electrodes (SPEs) were modified with alumina sol-gel (Al(2)O(3) sol-gel) derived film and gold nanoparticles i.e. AuNPs/Al(2)O(3)sol-gel/SPE. A thin film was formed by dripping Al(2)O(3) sol on SPE followed by electrochemical deposition of gold nanoparticles (AuNPs). The modified SPEs were characterized by scanning electron microscopy/energy dispersive X-ray analysis (SEM-EDAX), Raman spectra and voltammetric experiments. Antibodies in rabbit serum sample were allowed to react with the PfHRP-2 protein that was immobilized on the modified SPE to form antigen-antibody immune complex (PfHRP-2/anti-PfHRP-2). The bound antibodies were quantified by alkaline phosphatase (AP) enzyme labeled secondary antibodies (anti-rabbit immunoglobulins-AP conjugate). Enzymatic substrate, 1-naphthyl phosphate was converted to 1-naphthol by AP and an electroactive product was quantified using amperometry. The performances of the developed immunosensor and Dot-ELISA were tested against different dilutions of hyper immune serum (rabbit anti-PfHRP-2). Dot ELISA and the developed immunosensor (AuNPs/Al(2)O(3)sol-gel/SPE) results for the hyper immune serum containing anti-PfHRP-2 were distinctly positive when diluted upto 8 times (1 : 12800 dilution) and 11 times (1 : 102400 dilution), respectively. The developed immunosensor was applied for antibodies to PfHRP-2 in human clinical samples.