The Tulane accelerated physician training program (TAP-TP): A novel combination of scholarship and service.

INTRODUCTION: In spite of a projected shortage of physicians in the USA, the relatively long time and duration of training and high expense, the education of U.S. physicians has changed little over the past 120 years. METHODS: To address these issues, Tulane University developed a program, the Tulane accelerated physician training program (TAP-TP). This unique program allows selected Tulane undergraduate students to complete two years of undergraduate studies, followed by a mandatory year of public service, prior to four years of medical school. RESULTS: Students almost exclusively major in Cell and Molecular Biology (CMB), and used credits earned in Medical School to complete the required hours for their Bachelor's degree. The program was judged to be successful based on its ability to attract, retain, and graduate students into medical residency programs. The shortened time frame needed to complete the undergraduate program is associated with significant cost savings for the students. Educational outcomes were not statistically different between TAP-TP and traditional students despite the accelerated curriculum. CONCLUSIONS: TAP-TP is a unique model to graduate physicians in an accelerated fashion at significant cost savings.

Developing an opioid curriculum for medical students: A consensus report from a national symposium.

In June 2018, the Warren Alpert Medical School of Brown University hosted a national, multidisciplinary, interprofessional symposium on opioid curricula in undergraduate medical education. This article presents the consensus of an interprofessional group who attended a session focused on elements of an opioid curriculum, including key areas of content, teaching modalities, and learner assessment. This report also includes further directions and next steps for undergraduate medical education collaboration on opioid curricula.

The American Society of Hematology (ASH) Medical Educators Institute: a Pilot Faculty Development Project for Hematology Educators.

Clinician educators at academic medical centers often lack the community, mentorship, and faculty development to support their missions around education scholarship and teaching. Inadequate support for clinician educators can lead to professional dissatisfaction and slowed academic advancement. In 2014, ASH conducted a needs assessment of medical school hematology course directors, hematology-oncology fellowship program directors, and other ASH members identified as educators to determine this community's desire for faculty development in medical education. These data furthered the development of an annual faculty development program for hematology educators offering an interactive curriculum and support for an educational scholarly project. The needs assessment indicated that over 70% of respondents would be personally interested in a faculty development opportunity for hematology educators and only 11% had previously participated in such a program. A steering committee designed an intervention blending didactics, interactive small group exercises, webinars, mentorship for a scholarly project, 360-degree feedback for each participant, and a forum to discuss common career development goals. Of 42 applicants, 20 participants were chosen for the inaugural workshop. Following successful execution of the workshop, participants reported significant increase in confidence in the knowledge, skills, and attitudes targeted by the curriculum. A series of follow-up webinars have been developed to deliver additional content not covered during the workshop and to continue mentorship relationships. The curriculum will be further refined based on feedback from faculty and participants. Long-term outcome measurement will include tracking all participants' publications and presentations, time to promotion, and involvement in national medical education initiatives.

Medical Students' Exposure to the Humanities Correlates with Positive Personal Qualities and Reduced Burnout: A Multi-Institutional U.S. Survey.

BACKGROUND: Literature, music, theater, and visual arts play an uncertain and limited role in medical education. One of the arguments often advanced in favor of teaching the humanities refers to their capacity to foster traits that not only improve practice, but might also reduce physician burnout-an increasing scourge in today's medicine. Yet, research remains limited. OBJECTIVE: To test the hypothesis that medical students with higher exposure to the humanities would report higher levels of positive physician qualities (e.g., wisdom, empathy, self-efficacy, emotional appraisal, spatial skills), while reporting lower levels of negative qualities that are detrimental to physician well-being (e.g., intolerance of ambiguity, physical fatigue, emotional exhaustion, and cognitive weariness). DESIGN: An online survey. PARTICIPANTS: All students enrolled at five U.S. medical schools during the 2014-2015 academic year were invited by email to take part in our online survey. MAIN MEASURES: Students reported their exposure to the humanities (e.g., music, literature, theater, visual arts) and completed rating scales measuring selected personal qualities. KEY RESULTS: In all, 739/3107 medical students completed the survey (23.8%). Regression analyses revealed that exposure to the humanities was significantly correlated with positive personal qualities, including empathy (p < 0.001), tolerance for ambiguity (p < 0.001), wisdom (p < 0.001), emotional appraisal (p = 0.01), self-efficacy (p = 0.02), and spatial skills (p = 0.02), while it was significantly and inversely correlated with some components of burnout (p = 0.01). Thus, all hypotheses were statistically significant, with effect sizes ranging from 0.2 to 0.59. CONCLUSIONS: This study confirms the association between exposure to the humanities and both a higher level of students' positive qualities and a lower level of adverse traits. These findings may carry implications for medical school recruitment and curriculum design. "[Science and humanities are] twin berries on one stem, grievous damage has been done to both in regarding [them]... in any other light than complemental." (William Osler, Br Med J. 1919;2:1-7).

A Game Theory Approach for Strategic Partnerships in Academic Medicine.

Forming strategic partnerships is vital to academic health centers to further their missions of patient care, education, research, and community engagement. Formulating a strategy for such partnerships can be daunting due to the complexities of the health care landscape. The authors propose a game theory approach to partnership formation with the players being gatekeepers, facilitators, organizational employees, and economic buyers. Forming an academic partnership is not a game that is typically won or lost but is rather an ongoing engagement. Consistent with our game theory approach, the authors propose six basic rules to assist in successful strategic partnership formation for academic health centers.

A real options approach to clinical faculty salary structure.

One can use the option theory model originally developed to price financial opportunities in security markets to analyze many other economic arrangements such as the salary structures of clinical faculty in an academic medical center practice plan. If one views the underlying asset to be the portion (labeled "salary") of the economic value of the collections made for the care provided patients by the physician, then a salary guarantee can be considered a put option provided the physician, the guarantee having value to the physician only when the actual salary earned is less than the salary guarantee. Similarly, within an incentive plan, a salary cap can be thought of as a call option provided to the practice plan since a salary cap only has value to the practice plan when a physician's earnings exceed the cap. Further, based on analysis of prior earnings, the Black-Scholes options pricing model can be used both to price each option and to determine a financially neutral balance between a salary guarantee and a salary cap by equating the prices of the implied put and call options. We suggest that such analysis is superior to empirical methods for setting clinical faculty salary structure in the academic practice plan setting.

Healing and hope in the midst of devastation: reflections on Katrina in the aftermath of September 11.

This article reflects on Hurricane Katrina within the background and context of 9/11. Included are other tragedies experienced in the School of Medicine when, combined with 9/11, laid the foundation for our continued working through Katrina.

The medical school curate: an examination of student need.

The intense and encompassing nature of medical education can be overwhelming at times. The impact that this effect has on a student can be mitigated if adequately trained, spiritually focused advisors are available and present within the campus setting. This article presents real case examples of, and recommendations for, the role of medical school chaplaincies and why those chaplaincies should be a part of the culture of medical education.

Relationship between Medical School Diversity and Participation in the US News and World Report Survey.

INTRODUCTION: Reporting in USNWR rankings may reveal unintended, but important, sources of disparities with implications for medical school admissions and the future physician workforce. MATERIALS AND METHODS: To investigate relationships between allopathic medical school's student body diversity and participation in the US News and World Report Survey, we analyzed diversity statistics as listed in the Medical School Admissions Requirements (MSAR) database. These were compared to the institution's participation in the US News and World Report Survey for 152 US medical schools as either Primary Care or Research ranking. RESULTS & DISCUSSION: When considering USNWR rankings of research schools of medicine, those schools not participating in the survey had a 44.8% increase in UIM students. There was a statistical increase in the percentage of Latino/Hispanic students in schools that did not participate in the US News and World report survey as compared with those that did. Percentages of African American and Latino/Hispanic students were inversely correlated with US News and World Report research rankings. We suggest that participation in current publicly available allopathic medical school ranking platforms may have unintended and adverse consequences in maintaining a diverse medical school class and may impact longer-term goal of developing a diverse physician workforce that resembles the constituent population.

Estimating the value of medical education: a net present value approach.

BACKGROUND: Estimating the value of a medical education is a difficult undertaking. PURPOSE: As student debt levels rise and the role of managed care in price-setting increases, the financial benefit of an MD degree comes into question. METHODS: We developed a model using net present value (NPV) analysis for a range of annual costs of medical school attendance. Using this model, we determined the point at which pursuing a medical education is a "break-even" proposition from a financial perspective. RESULTS: The NPV of a medical education was positive for all annual costs of attendance from $10,000 to $100,000 and ranged from approximately $39,000 to $674,000 depending on the discount rate. Assuming a discount rate of 8%, only at an annual cost of attendance of $139,805 was the NPV = $0, which represents the break-even cost of medical education for a prospective student. CONCLUSIONS: Medical education is a financially advantageous undertaking for costs of attendance that far exceed even the most expensive schools in the United States. Our analysis suggests that based on economics, the supply of future physicians ought to be secure.

Organ donation by a prisoner: legal and ethical considerations.

The supply of available organs for donation is limited. In this article we describe the legal and ethical principles surrounding donation of organs from a prisoner.

Technological Innovation in Healthcare: Disrupting Old Systems to Create More Value for African American Patients in Academic Medical Centers.

Healthcare in the United States (U.S.) has made incredible advances, but inefficiency and high costs continue to permeate the system. Urban and underserved communities face the greatest array of healthcare problems including the need to improve the quality of care provided them, disproportionate levels of poverty among different groups in the U.S., and the number of unhealthy people disproportionately represented by mostly African American and Hispanic populations. Academic medical centers (AMCs) are major community stakeholders who work to fulfill the increasing healthcare demands of underserved communities. With the tripartite mission of delivering high quality care to patients, undertaking clinical and laboratory research, and training future health professionals, AMCs have a unique ability to address health concerns of the most vulnerable populations. Innovations in healthcare technology are critical to ensure that AMCs properly address health disparities and the specific health concerns of rapidly growing African American populations. Awareness of these disparities may lead to improved processes and protocol implementation, which can promote innovation and quality improvement to allow AMCs to remain a key player in addressing population-based clinical research, quality of care, and health disparities nationwide.

Blood doping: Then and now. A narrative review of the history, science and efficacy of blood doping in elite sport.

As the line between excellent and exceptional athletic performance narrows and as the financial remuneration for exceptional performance increases, unscrupulous athletes and their trainers will strive to enhance performance regardless of cost. One method of performance enhancement is by the augmentation of the oxygen-carrying capacity of the blood through blood doping. We discuss the science behind erythropoiesis and means by which these processes can be exploited to the potential advantage of the athlete. These include pre-sport transfusion practices as well as supplemental recombinant human erythropoietin (rHuEpo) and the use of newer erythropoietic agents, many of which have not received FDA approval. Finally, we discuss the data behind the efficacy of blood doping in an attempt to discern whether or not the practice actually works to improve athletic and competitive performance.

A comparison of match outcomes between traditional medical degree and dual-degree applicants.

BACKGROUND: Dual degrees combining and MD with another professional degree (MPH, MBA, or PhD) are becoming more common in an attempt to increase an applicant's competitivity for a residency. OBJECTIVE: This study was designed to assess differences in MD-only and dual degree MD applicants with respect to applicant characteristics and match outcomes. METHODS: Utilizing the voluntarily-reported publicly available 2017-2019 Texas STAR database, we assessed applicants from 115 medical schools. Texas STAR indicates that over this time period, there were 18,224 responses for a response rate of 43.8%. Comparisons were made between groups using student's t-test and chi-squared analysis. RESULTS: Compared to MD only students, MD/MPH applicants had a higher propensity towards primary care specialties. MD/PhD applicants did not differ versus MD only applicants in their selection of primary care specialties, or of competitive specialties. MD/MBA applicants chose more competitive specialties and less primary care specialties. Despite all these differences, match rates were not different comparing MD only and dual-degree students. CONCLUSIONS: Despite the growing popularity of combined MD programs, such programs do not appear to increase applicant match competitivity.

Successful treatment of hypereosinophilic syndrome with cyclosporine.

A 63-year-old man with lymphocytic variant hypereosinophilic syndrome (HES) characterized by a T-cell receptor gene rearrangement was treated with cyclosporine with marked improvement in his symptoms and reduction in his total eosinophil count. We present this as the first report to demonstrate cyclosporine as an effective treatment of HES in an adult.

How well did our students match? A peer-validated quantitative assessment of medical school match success: the match quality score.

Background: Assessment of an individual medical school's performance in the match is an important outcome of the educational program. Unfortunately, student rank lists are not public. A method to objectively gauge the quality of an institution's match regardless of student preference has not been described in the literature.Objective: This manuscript serves to determine the relative weights of included variables and derive a statistically valid Match Quality Score (MQS).Design: Between 2016 and 2018, student affairs experts derived from a national cohort validated the MQS by scoring factitious mini-match lists that covered three variables: student's Match Status, specialty Competitiveness, and residency program Reputation.Results: Of the variables assessed, only Match Status and Competitiveness were found to be significant. We derived the resulting coefficients for the Match Quality Score (MQS) as: [3.74A (# students successfully matched) + 2.34B (# students matching into their initial specialty in the SOAP process) + 1.77C (# students who secured a SOAP position in another specialty) + 0.26D (# students matching into a specialty where there are more applicants than spots)]/Total # students.Conclusions: The MQS is a potentially useful educational outcome measurement for US medical schools and may be considered as an outcome measure for continuous quality improvement to tailor future institutional changes to training, mentoring, and student-advising programs.

Medical school dean as a turnaround agent.

Taking on the role as a new medical school Dean in a new city after Hurricane Katrina posed many challenges. To facilitate turnaround, 3 principles were applied: hit the ground running, promote community involvement, and gain a common vision for the future. This article describes Tulane University's process for implementing change and expands on its vision for the future.

Impact of Hurricane Katrina on medical student academic performance: the Tulane experience.

BACKGROUND: Hurricane Katrina forced the temporary closure of Tulane University School of Medicine requiring relocation to the Texas Medical Center in Houston, Texas. This required curricular restructuring, and resulted in faculty/student challenges. The effect of these stresses on student performance was studied. METHODS: A pre-Katrina and post-Katrina comparative analysis of all Tulane medical students' performance on standardized exams, internal examination and United States Medical Licensing Examination (USMLE) step exams was performed. A one-way analysis of variance was used to determine if mean examination scores differed from pre-Katrina to post-Katrina. RESULTS: Internal examination scores did not differ significantly. National standardized examination grades significantly decreased pre-Katrina to post-Katrina in Biochemistry, Pharmacology, Pathology, Medicine, Pediatrics and Psychiatry (P < 0.05). There was no statistical change in USMLE scores. CONCLUSIONS: Tulane students had a statistically significant decline in performance on many course and clerkship examinations, though overall performance on licensing examinations was unchanged. Many stresses may have affected students' ability to perform.