Ipsilateral immunization after a prior SARS-CoV-2 mRNA vaccination elicits superior B cell responses compared to contralateral immunization.

mRNA vaccines have proven to be pivotal in the fight against COVID-19. A recommended booster, given 3 to 4 weeks post the initial vaccination, can substantially amplify protective antibody levels. Here, we show that, compared to contralateral boost, ipsilateral boost of the SARS-CoV-2 mRNA vaccine induces more germinal center B cells (GCBCs) specific to the receptor binding domain (RBD) and generates more bone marrow plasma cells. Ipsilateral boost can more rapidly generate high-affinity RBD-specific antibodies with improved cross-reactivity to the Omicron variant. Mechanistically, the ipsilateral boost promotes the positive selection and plasma cell differentiation of pre-existing GCBCs from the prior vaccination, associated with the expansion of T follicular helper cells. Furthermore, we show that ipsilateral immunization with an unrelated antigen after a prior mRNA vaccination enhances the germinal center and antibody responses to the new antigen compared to contralateral immunization. These findings propose feasible approaches to optimize vaccine effectiveness.

Opioid Overdose Prevention in Family Medicine Clerkships: A CERA Study.

BACKGROUND AND OBJECTIVES: The national opioid crisis requires medical education to develop a proactive response centering on prevention and treatment. Primary care providers (PCPs)-many of whom are family medicine physicians-commonly treat patients on opiates, and write nearly 50% of opioid prescriptions. Despite linkages between PCP opioid prescribing patterns and the associated potential for overdose, little is known about how family medicine clerkship students are trained to prevent opioid overdose, including training on the use of naloxone. This study describes the presence of opioid overdose education at the national level and barriers to inclusion. It also discusses implementation strategies along with instructional methodology and learner evaluation. METHODS: Data were collected as part of a cross-sectional survey administered electronically by the Council of Academic Family Medicine Educational Research Alliance to 139 family medicine clerkship directors. RESULTS: A total of 99 clerkship directors (71.2% response rate) responded to the survey. A large majority (86.4%) agreed that it is important to offer opioid overdose prevention education in the clerkship, yet only 25.8% include this topic. Of these, only 50.0% address naloxone use. The most common barriers to including opioid overdose prevention education were prioritization of educational topics (82.1%) followed by lack of available faculty with sufficient experience/expertise (67.7%). CONCLUSIONS: Findings point to a disparity between perceived importance of opioid overdose prevention education and inclusion of this topic in family medicine clerkship-level medical education. Innovative use of online education and partnering with community resources may address barriers related to curricular prioritization while supporting interprofessional education principles.

Practice-based learning and improvement in family medicine student clerkships: a CERA study.

BACKGROUND: Practice-based learning and improvement (PBLI) has been promoted as a key component of competency-based training in medical student education, but little is known about its implementation. METHODS: This project is part of a larger CERA omnibus survey of family medicine medical student clerkship directors carried out from July to September 2012. Analyses were conducted to assess clerkship infrastructure, learner assessment and feedback, and clerkship director perceptions of PBLI curricula. RESULTS: The majority (69.0%, 58/82) of family medicine clerkship directors reported that PBLI is not included in their clerkship. Significant predictors of PBLI in the curriculum include: regularly scheduled centralized teaching (weekly or more versus less than weekly, OR=1.14, 95% CI=1.01--1.29) and clerkship director belief that students should achieve PBLI competency (agree in competency versus disagree in competency, OR=1.19, 95% CI=1.08--1.30). Few (20.5%, 16/78) family medicine clerkship directors reported that the amount of PBLI in their curriculum is likely to increase in the next 12 months. The duration of the clerkship was a significant predictor of reported likelihood of increasing PBLI over the next 12 months (3 weeks versus 8 weeks, OR=1.23, 95% CI=1.00--1.51). CONCLUSIONS: Despite increased emphasis on quality improvement activities in practice, most family medicine clerkships do not currently offer PBLI curricula. Additionally, less than one in four family medicine clerkships plan on increasing the amount of PBLI curricula in the next 12 months. Continued research in this area is needed to identify successful models for PBLI curricular offerings.

Trends in patient encounters: implications for family medicine clerkships.

BACKGROUND AND OBJECTIVES: Adequate and equivalent clinical experience is related to the number and diagnoses of patients encountered and should provide students with experiences similar to community practice. This study compares the distribution of diagnoses family medicine clerkship students encountered at a Midwest medical school during 2009-2011 with both 1997-1999 data and the 2010 National Ambulatory Medical Care Survey (NAMCS) samples of family physicians and all physicians. METHODS: Electronically submitted encounter data (2009-2011) were compared to logbook data (1997-1999) and to the 2010 NAMCS data listing primary diagnoses at office visits in the United States by major disease category. RESULTS: Of the 15 diagnoses with ≥150 encounters, seven increased and eight decreased between the two time periods. The relative percent ratio of clerkship diagnoses distribution to the NAMCS family physician distribution revealed that diagnoses ratios were ≤100% in eight categories (clerkship experiences