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OBJECTIVES: Medical education is required to ensure a healthy training and learning environment for resident physicians. Trainees are expected to demonstrate professionalism with patients, faculty, and staff. West Virginia University Graduate Medical Education (GME) initiated a Web-based professionalism and mistreatment form ("button") on our Web site for reporting professionalism breaches, mistreatment, and exemplary behavior events. The purpose of this study was to identify characteristics in resident trainees who had a "button push" activation about their behavior to better understand ways to improve professionalism in GME. METHODS: This West Virginia University institutional review board-approved quality improvement study is a descriptive analysis of GME button push activations from July 2013 through June 2021. We compared characteristics of all of those trainees who had specific button activation(s) about their behavior. Data are reported as frequency and percentage. Nominal data and interval data were analyzed using the χ2 and the t test, respectively. P < 0.05 was significant. Logistic regression was used to analyze those differences that were significant. RESULTS: In the 8-year study period, there were 598 button activations, and 54% (n = 324) of the activations were anonymous. Nearly all of the button reports (n = 586, 98%) were constructively resolved within 14 days. Of the 598 button activations, 95% (n = 569) were identified as involving one sex, with 66.3% (n = 377) identified as men and 33.7% (n = 192) as women. Of the 598 activations, 83.7% (n = 500) involved residents and 16.3% (n = 98) involved attendings. One-time offenders comprised 90% (n = 538), and 10% (n = 60) involved individuals who had previous button pushes about their behavior. CONCLUSIONS: Implementation of a professionalism-monitoring tool, such as our Web-based button push, identified gender differences in the reporting of professionalism breaches, because twice as many men as women were identified as the instigator of a professionalism breech. The tool also facilitated timely interventions and exemplary behavior recognition.
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Internato e Residência , Profissionalismo , Masculino , Humanos , Feminino , Fatores Sexuais , Educação de Pós-Graduação em Medicina , InternetRESUMO
OBJECTIVES: A paucity of information exists to advise medical school applicants who have had to retake the Medical College Admission Test (MCAT) to achieve a competitive score. To better advise repeat test takers from West Virginia and other Appalachian and southern areas, MCAT data from West Virginia applicants were analyzed and compared with national data. METHODS: In the application cycles of 2017-2020, the following factors were analyzed in relation to medical school acceptance in West Virginia applicants: MCAT scores, the number of test-taking attempts, biology-chemistry-physics-math grade point average, time between test-taking attempts, and academic major. MCAT data from medical school applicants from West Virginia who took the test more than once also were compared with national data. RESULTS: Of the total repeat test takers from West Virginia (N = 285) in the study timeframe, 57 (20%) were ultimately accepted into medical school. Factors associated with medical school acceptance were as follows: first MCAT test score (odds ratio [OR] 1.3, 95% confidence level [CL] 1.2-1.4, P < 0.001), change in MCAT test score (OR 1.2, 95% CL 1.1-1.3, P = 0.0015), and biology-chemistry-physics-math grade point average (OR 15.1, 95% CL 4.2-54.8, P < 0.0001). The highest benefit for improved scores occurred between the first and second attempts. The highest point gain occurred when the first MCAT score was in the range of 477 to 487 (<1st-12th percentile); this finding was not found in the national data. CONCLUSIONS: Although the study was limited to West Virginia medical school applicants, this information could prove useful in advising premedical applicants from other Appalachian and southern US areas.
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Medicina Osteopática/educação , Estudantes de Medicina/estatística & dados numéricos , Habilidades para Realização de Testes/normas , Avaliação Educacional/métodos , Avaliação Educacional/estatística & dados numéricos , Humanos , Razão de Chances , Medicina Osteopática/estatística & dados numéricos , Medicina Osteopática/tendências , Estudantes de Medicina/psicologia , Habilidades para Realização de Testes/psicologia , Habilidades para Realização de Testes/estatística & dados numéricos , West VirginiaRESUMO
ABSTRACT: Pediatric emergency medicine providers must be astute at generating the differential diagnosis and performing the appropriate evaluation to promptly determine the underlying cause of new onset paraplegia. Spinal cord infarction (SCI) is a potential etiology of paraplegia in children, and fibrocartilaginous embolization is a rare underlying cause of SCI. We present an illustrative case of SCI secondary to fibrocartilaginous embolization in an otherwise healthy adolescent who developed symptoms of spinal cord dysfunction after basketball play.
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Basquetebol , Embolia , Adolescente , Criança , Embolia/etiologia , Embolia/terapia , Humanos , Infarto/etiologia , Paraplegia/etiologia , Medula EspinalRESUMO
PURPOSE: To improve health equity, dental and medical students must have a firm grasp of the proper use of race as a social construct. The purpose of this study was to determine the degree to which an innovative learning event affected students' understanding of race as a social construct. It also sought to examine the effects that personally experienced and/or witnessed racism and previous education had on students' responses to the learning event. METHODS: In 2022, all incoming first-year dental (N = 48) and medical (N = 114) students completed an online pre-matriculation assignment about the use of race in healthcare. Students initially completed an anonymous 14-item pre-survey and then read assigned publications, followed by answering questions about a real-life vignette concerning the topic of race as a social construct. Students finished the assignment by completing an anonymous seven-item post-survey. Data from the pre- and post-surveys were collected and analyzed to assess if differences existed among students and between the two surveys. RESULTS: Dental and medical students were significantly more likely to endorse race as a social construct after the learning experience (p < 0.001). Students who had experienced discrimination or obtained training were more likely to define race as a social construct before and after the learning event. CONCLUSION: Dental and medical schools can increase students' understanding of race as a social construct, rather than a biological construct, with educational interventions.
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Racismo , Estudantes de Medicina , Humanos , Estudantes de Odontologia , Aprendizagem , Inquéritos e QuestionáriosRESUMO
Dent disease is an X-linked proximal tubulopathy that typically presents with hypercalciuria, low-molecular-weight proteinuria and slow progression to endstage renal disease. We report the case of a 5-year-old boy who presented with asymptomatic nephrotic range proteinuria and was later diagnosed with Dent disease. Absence of specific glomerular pathology in the first kidney biopsy led to erroneous treatment for presumably unsampled primary focal segmental glomerulosclerosis. Aggressive angiotensin blockade and immunosuppression resulted in significant side effects with marginal benefit. The continued nonspecific findings after a second kidney biopsy 2 years later led to the suspicion of a congenital tubulopathy. We detected a novel CLCN5 gene mutation, c.1396G > C, that creates a G466R missense change in the ClC-5 protein. Dent disease should be considered in the differential diagnosis of asymptomatic proteinuria for male patients. Profiling proteinuria in these patients by spot urine albumin/creatinine ratio may give the first clue to a tubulopathy. Determining the extent to which the clinical work-up should proceed for females with Dent phenotype or asymptomatic proteinuria remains to be a challenging clinical dilemma.
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Canais de Cloreto/genética , Glomerulosclerose Segmentar e Focal/genética , Mutação , Proteinúria/genética , Pré-Escolar , Glomerulosclerose Segmentar e Focal/patologia , Humanos , Rim/patologia , Masculino , Proteinúria/patologiaRESUMO
INTRODUCTION: Service members and veterans applying to medical schools can be a challenging experience. Often, the applicants have difficulty providing descriptions of their experiences. Additionally, their pathway to medical school is significantly different compared to traditional applicants. We sought to determine if there were statistically significant factors within a cohort of U.S. military medical school applications to a U.S.-based allopathic medical school to provide recommendations on how to best advise military applicants. METHODS: Data about social, academic, and military factors were collected and analyzed from the American College Application Service (AMCAS) applications to the West Virginia University School of Medicine (WVU SoM) from the 2017 to 2021 cycles. Eligibility criteria included the applications that indicated that the applicant listed any type of military experience. RESULTS: In the 5-year study period, there were 25,514 applicants to the WVU SoM, and 1.6% (n = 414) self-identified as military applicants. Of the military applicants, 28 (7%) were accepted to the WVU SoM. Statistically significant differences were found in several factors, including but not limited to academic performance, number of total experiences (14.5 vs. 12, P = .01), and number of military experiences (4 vs. 2, P = .003) listed on the AMCAS applications. In the accepted group, 88% of the applications included information about military experiences, which was understandable to the nonmilitary researchers compared to 79% in the nonaccepted group (P = .24). CONCLUSIONS: Premedical advisors can share statistically significant findings with military applicants, so they are informed about the academic and experiential factors associated with medical school acceptance. Applicants should also be advised to provide clear explanations of any military lexicon used in their applications. Although not statistically significant, there were a higher percentage of applications that contained descriptions of military language that was understandable to the civilian researchers in the accepted group vs. the nonaccepted group.
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Medicina , Veteranos , Humanos , Estados Unidos , Faculdades de Medicina , Universidades , Fatores SexuaisRESUMO
INTRODUCTION: The medical literature is scant with reports of twins diagnosed with nephrotic syndrome associated with genetic mutations. Mutations in the protein coding paired box gene 2 (PAX2) and in the non-muscle class I myosin, myosin 1E, (MYO1E) have been implicated in the development of steroid-resistant nephrotic syndrome. We describe the first case, to our knowledge, of the concordant presentation of nephrotic syndrome in twins with simultaneous mutations in PAX2 and MYO1E. CASE REPORT: At 32 months and 33 months of age, monochorionic, diamniotic twin girls presented with nephrotic syndrome. Each twin experienced three relapses during or after completion of corticosteroid treatment. Sustained remission was achieved with tacrolimus. Genetic testing of each twin revealed two heterozygous mutations of MYO1E and one homozygous mutation of PAX2. Renal biopsy results of one twin revealed pathologic findings consistent with minimal change nephropathy. The twins' phenotypes have been essentially identical. CONCLUSION: Our cases add to the scant medical literature addressing nephrotic syndrome in twins with genetic mutations. Close monitoring of our unique patients will provide novel information about the clinical significance of combined mutations in PAX2 and MYO1E.
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PURPOSE/OBJECTIVE: Due to the coronavirus pandemic, virtual interviews became a mainstay of graduate dental and medical education selection processes. To gain a handle on how to navigate lingering uncertainties about how interviews should be conducted in the future, this study examined the benefits and pitfalls of the virtual interview process (VIP) and assessed program plans to implement in the next interview cycle. METHODS: An anonymous online survey, for completion by one program representative (director or associate director), was sent to graduate medical education (GME) and advanced dental education programs at West Virginia University (N = 74). RESULTS: Fifty-two (52) of the programs (70%) completed the survey. Zoom was the most frequently used interview platform (78.8%). Approximately two thirds (65.4%) of the interviewers thought VIP allowed the program to promote the university, the school, and their program and also reported experiencing video-conferencing fatigue. About six in 10 perceive VIP can introduce bias in selecting applicants (59.6%) and potentially disadvantage some applicants (67.3%). Compared to the previous in-person cycle, 67.4% of programs invited more applicants, and 73.1% interviewed more applicants. Regarding the 2021-2022 interview cycle, 55.8% of programs plan to offer either an in-person or VIP, while 7.7% plan to keep their process completely virtual. CONCLUSION: Graduate programs in this study demonstrated the indispensability of technology in transitioning from in-person to virtual interviews during COVID-19 pandemic. VIP has several advantages and disadvantages; this style of interview is forecasted to have a presence in applicant selection in the future.
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COVID-19 , Internato e Residência , COVID-19/epidemiologia , Humanos , Pandemias , SARS-CoV-2 , Inquéritos e QuestionáriosRESUMO
Maternal and obstetrical outcomes vary widely within the United States. The impact of insurance type on health care disparities and its influence on obstetrical care and maternal outcome is not clear. We report the impact of health care insurance on obstetrical and maternal outcomes in a tertiary care health care system. Our maternal quality care database (n = 4199) was queried comparing commercial insurance to government sponsored insurance from July 1, 2015 through June 30, 2018. Parturients with commercial insurance were older, weighed more, presented with less gravidity and parity, had more advanced gestation, and had a higher neonatal 5-minute Apgar score than government insured parturients. Additionally, government insured parturients were less likely to be admitted for induction with oxytocin, receive labor epidural analgesia, and have a primary caesarean delivery. Similarly, government insured parturients were more likely to be of African American descent, be a current known smoker, have a positive urine drug screen, and receive a general anesthetic. We conclude obstetrical and maternal health care disparities exist based on medical insurance type.
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Analgesia Epidural , Analgesia Obstétrica , Seguro , Trabalho de Parto , Cesárea , Feminino , Humanos , Recém-Nascido , Gravidez , Estados UnidosAssuntos
Transtorno Autístico/complicações , Febre/etiologia , Hipnóticos e Sedativos/efeitos adversos , Humor Irritável , Síndrome Maligna Neuroléptica/diagnóstico , Pneumonia por Mycoplasma/diagnóstico , Adolescente , Humanos , Intubação Intratraqueal , Masculino , Síndrome Maligna Neuroléptica/complicações , Cooperação do Paciente , Pneumonia por Mycoplasma/complicações , Pneumonia por Mycoplasma/tratamento farmacológico , Insuficiência Respiratória/etiologia , Insuficiência Respiratória/terapiaRESUMO
Barrett's esophagus in children with peptic strictures has not been well characterized, and its prevalence is unknown. We report a case of peptic esophageal stricture with Barrett's esophagus in an adolescent patient who presented with dysphagia with recurrent episodes of vomiting and limited medical history. A 13-year-old male with mild intellectual disability was transferred to our facility due to a two-month history of dysphagia with recurrent episodes of vomiting and intolerance to both solids and liquids. Physical examination and laboratory values were within normal limits, including complete blood count and differential, serum electrolytes, glucose, amylase, lipase, liver and kidney function tests, and thyroid-stimulating hormone level. Barium esophagram revealed persistent focal narrowing of the proximal and mid-esophagus. An esophageal endoscopy revealed a snug circumferential stricture and biopsy consistent with erosive esophagitis. The patient was started on high dose pantoprazole and underwent serial endoscopic guided balloon dilations with marked improvement in symptoms. Peptic stricture with Barrett's esophagus is rare in children. It should be included in the differential diagnosis of a child with the common symptom of vomiting in the setting of developmental delay. Vigorous treatment with endoscopic balloon dilation and proton pump inhibitors is necessary to prevent the progression into adenocarcinoma.
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A 16-year-old adolescent boy presented with headache, dizziness, loss of consciousness, and a tonic-clonic seizure after heading a soccer ball in a competitive match. A computed tomographic scan of the head revealed an acute subdural hematoma with a mass effect. The patient was emergently referred to a tertiary care facility where he eventually recovered completely with conservative care. No predisposing medical conditions were found. To the best of our knowledge, this is the first report of an intracranial hemorrhage secondary to the heading of a soccer ball alone in an otherwise healthy child without any underlying predisposing central nervous system abnormalities.
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Traumatismos Cranianos Fechados/complicações , Hematoma Subdural Agudo/etiologia , Futebol/lesões , Adolescente , Anticonvulsivantes/uso terapêutico , Seguimentos , Traumatismos Cranianos Fechados/diagnóstico , Traumatismos Cranianos Fechados/tratamento farmacológico , Hematoma Subdural Agudo/diagnóstico , Hematoma Subdural Agudo/tratamento farmacológico , Humanos , Imageamento por Ressonância Magnética , Masculino , Convulsões/etiologia , Convulsões/prevenção & controle , Tomografia Computadorizada por Raios XRESUMO
Enuresis is a frequent complaint not always volunteered by parents or patients. The pediatric clinician has to inquire about enuresis to break the secrecy surrounding this symptom that could be related to a more serious underlying renal, endocrine, or psychosocial disease. Determining the type of enuresis is crucial to offer optimal treatment. We present a review for the pediatric clinician to optimize their care of the child with monosymptomatic enuresis. [Pediatr Ann. 2018;47(10):e390-e395.].
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Enurese Noturna/terapia , Criança , Pré-Escolar , Humanos , Enurese Noturna/diagnóstico , Enurese Noturna/etiologia , Pais , Pediatria/métodos , Médicos de Atenção Primária , Atenção Primária à Saúde/métodosRESUMO
This report describes a case of posttransplant lymphoproliferative disease in a 19-year-old male patient with an initial diagnosis of peritonsillar abscess. As the number of children receiving transplants continues to increase, the pediatrician must become familiar with the possible presentations of posttransplant lymphoproliferative disease and at least consider it as a diagnosis in any ill child under long-term treatment with immunosuppressive agents. The epidemiology, pathogenesis, clinical presentations, evaluation, prognosis, and treatment of posttransplant lymphoproliferative disease are reviewed for the primary care pediatrician.
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Imunossupressores/uso terapêutico , Transplante de Rim/efeitos adversos , Doadores Vivos , Transtornos Linfoproliferativos/fisiopatologia , Abscesso Peritonsilar/tratamento farmacológico , Adulto , Humanos , Transtornos Linfoproliferativos/epidemiologia , Transtornos Linfoproliferativos/patologia , Masculino , PrognósticoRESUMO
Young female patients with gynecologic complaints, including vaginal discharge, commonly seek care in the emergency department. Prepubertal vaginal discharges have various potential etiologies including nonspecific vulvovaginitis, infections, inflammatory or dermatologic processes, precocious puberty, malignancy, anatomical anomaly, trauma, sexual abuse, and foreign body. We present the case of a 4-year-old girl with vaginal odor and discharge secondary to a foreign body. The foreign body was part of a toy, the lower half of the patient's missing "Bratz" (MGA Entertainment) doll. Although it is well known that a vaginal foreign body can cause a vaginal discharge, the unusual nature of the foreign body in this case and the revealing radiograph made this a case of particular interest.
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Corpos Estranhos/diagnóstico por imagem , Vagina/diagnóstico por imagem , Descarga Vaginal/etiologia , Pré-Escolar , Feminino , Corpos Estranhos/complicações , Humanos , Jogos e Brinquedos , RadiografiaAssuntos
Datura , Encefalocele/diagnóstico , Alucinógenos/efeitos adversos , Neoplasias da Próstata/diagnóstico , Rabdomiólise/diagnóstico , Rabdomiossarcoma/diagnóstico , Adolescente , Pré-Escolar , Alucinógenos/administração & dosagem , Humanos , Lactente , Imageamento por Ressonância Magnética , Masculino , Staphylococcus aureus Resistente à Meticilina/isolamento & purificação , Neoplasias da Próstata/terapia , Rabdomiólise/terapia , Rabdomiossarcoma/terapia , Sementes , Retenção Urinária/etiologiaRESUMO
Twelve cases of pyomyositis treated at a rural tertiary care referral center are reported and compared to other published cases of this disorder in the United States. About 350 cases have been reported nationally and over a quarter of them are in patients infected with human immunodeficiency virus (HIV). Pyomyositis, classically a disease of the healthy young male, starts insidiously and progresses to a pus filled abscess of a muscle or a group of muscles. It is a clinical diagnosis often misdiagnosed and therefore treatment is delayed. Imaging studies are conclusive in most cases by the time of presentation. Our series has a predominance of older females, no HIV positive patients and is unique in comparison to previously reported trends and cases.
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Piomiosite/diagnóstico , Adolescente , Adulto , Idoso , Antibacterianos , Criança , Pré-Escolar , Feminino , Humanos , Imageamento por Ressonância Magnética , Masculino , Pessoa de Meia-Idade , Músculo Esquelético/patologia , Piomiosite/etiologia , Piomiosite/patologia , Estudos Retrospectivos , Fatores de RiscoRESUMO
This article was migrated. The article was marked as recommended. In-person interviewing is the norm during the medical school application process, but it is not always possible due to reasons such as exorbitant cost of travel, work or residence outside the country and adverse travel conditions. In January 2016 during Winter Storm Jonas in the eastern United States of America, officials at the West Virginia University School of Medicine (WVU SOM) mandated a closure of the campus resulting in the cancellation of twenty on-site medical school interviews. The impromptu solution to overcoming this obstacle to in-person interviewing is described here as a case study. The successful use of digital interviewing has already been described at the residency and fellowship level; we believe this is the first reported case study about the successful use of FaceTime interviewing at the medical school level, and it may encourage admissions officials to expand the use of this modality in medical student recruitment.
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The goal of this issue is to encourage the pediatrician to view these sensitive health issues from many different angles so that the effects on the adolescent's life can be better appreciated. The initial step involves effectively engaging the patient to unmask the concerns and then providing the optimal available treatment.